Eligibility and utilization of implantable cardioverter-defibrillators in a regional STEMI system

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• 作者：Benjamin K. Johnson ; MD^* ; ^&dagger ; ; Ross F. Garberich ; MS^* ; Timothy D Henry ; MD^* ; ^&Dagger ; ; William T. Katsiyiannis ; MD ; FHRS^* ; Jay Sengupta ; MD^* ; Ankur Kalra ; MD^* ; Robert G. Hauser ; MD ; FHRS^* ; Meghan E. Lardy^* ; Marc C. Newell ; MD^* ; ^{Marc.Newell@allina.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ICD ; implantable cardioverter-defibrillator ; LV ; left ventricle ; LVEF ; left ventricular ejection fraction ; MHI ; Minneapolis Heart Institute ; MI ; myocardial infarction ; NYHA ; New York Heart Association ; PCI ; percutaneous coronary intervention ; STEMI ; ST-elevation myocardial infarction
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：13
• 期：2
• 页码：538-546
• 全文大小：279 K

文摘

Studies have shown mortality benefit for implantable cardioverter-defibrillators (ICDs) in ST-elevation myocardial infarction (STEMI) patients with reduced left ventricular ejection fraction (LVEF), but contemporary eligibility and appropriate utilization of ICDs is unknown.

d="absSec_2">Objective

d="sp0070">The purpose of this study was to determine the contemporary eligibility and appropriate utilization of ICDs post-STEMI.

d="absSec_3">Methods

d="sp0075">Using the prospective Minneapolis Heart Institute regional STEMI registry, LVEF before discharge and at follow-up were stratified into 3 groups: normal (LVEF ≥50%), mildly reduced (LVEF 35%&ndash;49%), and severely reduced (LVEF <35%).

d="absSec_4">Results

d="sp0080">From March 2003 to June 2012, 3626 patients were treated. Patients with in-hospital death (n = 187), ICD in place (n = 21), negative cardiac biomarkers (n = 337), and undocumented in-hospital LVEF (n = 9) were excluded, leaving 3072 patients in the final analysis, including 1833 (59.7%) with LVEF ≥50%, 875 (28.5%) with LVEF between 35% and 49%, and 364 (11.8%) with LVEF <35% before hospital discharge. Overall, 1029 patients (33.5%) underwent follow-up echocardiography ≥40 days post-STEMI, including 140 of the 364 patients (38.5%) discharged with LVEF <35%. In total, 73 patients (7.1%) with follow-up echocardiography ≥40 days post-STEMI met criteria for an ICD (68 LVEF ≤30%, 5 LVEF 30%&ndash;35%, and New York Heart Association class II or greater). Only 26 of these patients (35.6%) underwent ICD placement within 1 year post-STEMI. Overall, only 10% to 15% of potentially eligible patients had an ICD implemented.

d="absSec_5">Conclusion

d="sp0085">Rates of ICD implantation in appropriate STEMI patients after 40 days are low. Strategies are needed to identify and expand access to these high-risk patients.