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Open Access Research article

Influence of time between last myocardial infarction and prophylactic implantable defibrillator implant on device detections and therapies. “Routine Practice” data from the SEARCH MI registry

Giuseppe Boriani1*, Gianluca Botto2, Maurizio Lunati3, Alessandro Proclemer4, Boris Schmidt5, Ali Erdogan6, Werner Rauhe7, Mauro Biffi1, Elisabetta Santi8, Daniel Becker9, Marc Messier9 and Massimo Santini10

Author Affiliations

1 Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi; Via Massarenti, 9 40138, Bologna, Italy

2 Cardiology Department, Como, Italy

3 Cardiology Department, Hospital, Niguarda, Milano, Italy

4 Cardiology Department, Udine, Italy

5 Cardiology Department, Freiburg Im Breisgau, Germany

6 Cardiology Department, Giessen, Germany

7 Cardiology Department, Bolzano, Italy

8 Medtronic Italia, Roma, Italy

9 Medtronic, Maastricht, Netherlands

10 Cardiology Department, S.Filippo Neri Hospital, Roma, Italy

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BMC Cardiovascular Disorders 2012, 12:72  doi:10.1186/1471-2261-12-72

Published: 11 September 2012

Abstract

Background

A multicenter European Registry, SEARCH-MI, was instituted in the year 2002 in order to assess patients’ outcomes and ICD interventions in patients with a previous MI and depressed LV function, treated with an ICD according to MADIT II results. In this analysis, we evaluate the influence of the time elapsed between last myocardial infarction (MI) and prophylactic cardioverter defibrillator (ICD) implant on device activations.

Methods

643 patients with left ventricular dysfunction (mean LVEF 26 ± 5%) and NYHA class I-III were prospectively followed for 1.8 ± 1.2 years in a multicenter registry. The population was divided into 3 groups according to the time between last MI and ICD implant: [1] from 40 days to less than 1.5 years; [2] from 1.5 to less than 7 years and [3] at least 7 years.

Results

The cumulative incidence of ventricular tachyarrhymias and appropriate device therapy (ATP or shock) were higher in patients implanted longer time from last MI (Gray’s Test p = 0.002 and p = 0.013 respectively). No significant differences were seen in all cause mortality (Gray’s Test p = 0.618) or sudden cardiac death across the MI stratification groups (Gray’s Test p = 0.663).

Conclusions

Patients implanted with an ICD longer after the MI have a higher chance of presenting ventricular tachyarrhythmias and appropriate ICD therapy, while no differences were seen in overall mortality. These observations may be important for improving patient targeting in sudden death prevention.

Keywords:
Cardioverter defibrillator; Myocardial infarction; Registry; Sudden death; Ventricular tachyarrhythmias.