BACKGROUND: Current approaches to coronary artery disease (CAD) and acute myocardial infarction (MI) may not be well represented in most primary prevention trials of sudden cardiac death (SCD). METHODS: The contemporary and ongoing registry of the Rostock infarction network (Drip & Ship) represents a well-defined cohort of patients subjected to percutaneous coronary intervention (PCI) for ST-elevation infarction (STEMI) and served as the database for both candidates for an ICD for primary prevention of SCD and for sudden death (SCD) or ventricular tachycardia (VT) during follow-up. RESULTS: A total of 855 consecutive patients were treated with PCI for STEMI or NSTEMI in the region of Rostock (Germany) between 2001 and 2004. While all cause mortality was still 17.2%, the SCD rate was low at 1.3% during 728 ± 366 days of follow-up. Within that time 85 patients (9.9%) developed an indication for ICD therapy due to an impaired LV function (LVEF ≤ 35%) and heart failure. Univariate predictors of an ICD indication were delayed reperfusion (p = 0.001), a high creatine kinase (CK) max (p = 0.009), a persistent wide QRS complex (p = 0.001), previous cerebrovascular events (p = 0.033), and chronic renal failure (p = 0. 001). However, only 16.5% of these patients qualifying for an ICD actually received an ICD; nevertheless, the actual SCD rate was only 3.5%, while 5.4% (46 patients) suffered VTs or ventricular fibrillation (VF). The SCD/VT rate in the entire infarct population was associated with time to reperfusion (0.032), left bundle-branch block (0.002), a longer history of CAD (0.032), and VT during follow-up. CONCLUSION: While mortality in patients with STEMI is still alarming even with PCI, the risk of SCD may be considerably decreased even in patients with an LVEF below 35%. With the current approach to primary prevention of sudden cardiac death, approximately 10% of postinfarction patients qualify for ICD therapy; however this may only reach a quarter of patients prone to SCD.
BACKGROUND: Current approaches to coronary artery disease (CAD) and acute myocardial infarction (MI) may not be well represented in most primary prevention trials of sudden cardiac death (SCD). METHODS: The contemporary and ongoing registry of the Rostock infarction network (Drip & Ship) represents a well-defined cohort of patients subjected to percutaneous coronary intervention (PCI) for ST-elevation infarction (STEMI) and served as the database for both candidates for an ICD for primary prevention of SCD and for sudden death (SCD) or ventricular tachycardia (VT) during follow-up. RESULTS: A total of 855 consecutive patients were treated with PCI for STEMI or NSTEMI in the region of Rostock (Germany) between 2001 and 2004. While all cause mortality was still 17.2%, the SCD rate was low at 1.3% during 728 ± 366 days of follow-up. Within that time 85 patients (9.9%) developed an indication for ICD therapy due to an impaired LV function (LVEF ≤ 35%) and heart failure. Univariate predictors of an ICD indication were delayed reperfusion (p = 0.001), a high creatine kinase (CK) max (p = 0.009), a persistent wide QRS complex (p = 0.001), previous cerebrovascular events (p = 0.033), and chronic renal failure (p = 0. 001). However, only 16.5% of these patients qualifying for an ICD actually received an ICD; nevertheless, the actual SCD rate was only 3.5%, while 5.4% (46 patients) suffered VTs or ventricular fibrillation (VF). The SCD/VT rate in the entire infarct population was associated with time to reperfusion (0.032), left bundle-branch block (0.002), a longer history of CAD (0.032), and VT during follow-up. CONCLUSION: While mortality in patients with STEMI is still alarming even with PCI, the risk of SCD may be considerably decreased even in patients with an LVEF below 35%. With the current approach to primary prevention of sudden cardiac death, approximately 10% of postinfarction patients qualify for ICD therapy; however this may only reach a quarter of patients prone to SCD.
Authors: Douglas P Zipes; A John Camm; Martin Borggrefe; Alfred E Buxton; Bernard Chaitman; Martin Fromer; Gabriel Gregoratos; George Klein; Arthur J Moss; Robert J Myerburg; Silvia G Priori; Miguel A Quinones; Dan M Roden; Michael J Silka; Cynthia Tracy; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Elliott M Antman; Jeffrey L Anderson; Sharon A Hunt; Jonathan L Halperin; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Silvia G Priori; Jean-Jacques Blanc; Andrzej Budaj; A John Camm; Veronica Dean; Jaap W Deckers; Catherine Despres; Kenneth Dickstein; John Lekakis; Keith McGregor; Marco Metra; Joao Morais; Ady Osterspey; Juan Luis Tamargo; José Luis Zamorano Journal: J Am Coll Cardiol Date: 2006-09-05 Impact factor: 24.094
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: Stefan H Hohnloser; Karl Heinz Kuck; Paul Dorian; Robin S Roberts; John R Hampton; Robert Hatala; Eric Fain; Michael Gent; Stuart J Connolly Journal: N Engl J Med Date: 2004-12-09 Impact factor: 91.245
Authors: Gust H Bardy; Kerry L Lee; Daniel B Mark; Jeanne E Poole; Douglas L Packer; Robin Boineau; Michael Domanski; Charles Troutman; Jill Anderson; George Johnson; Steven E McNulty; Nancy Clapp-Channing; Linda D Davidson-Ray; Elizabeth S Fraulo; Daniel P Fishbein; Richard M Luceri; John H Ip Journal: N Engl J Med Date: 2005-01-20 Impact factor: 91.245
Authors: Scott D Solomon; Steve Zelenkofske; John J V McMurray; Peter V Finn; Eric Velazquez; George Ertl; Adam Harsanyi; Jean L Rouleau; Aldo Maggioni; Lars Kober; Harvey White; Frans Van de Werf; Karen Pieper; Robert M Califf; Marc A Pfeffer Journal: N Engl J Med Date: 2005-06-23 Impact factor: 91.245
Authors: H Schneider; F Weber; L Paranskaja; C Holzhausen; M Petzsch; R Severin; C A Nienaber Journal: Dtsch Med Wochenschr Date: 2004-10-08 Impact factor: 0.628
Authors: David J Wilber; Wojciech Zareba; W Jackson Hall; Mary W Brown; Albert C Lin; Mark L Andrews; Martin Burke; Arthur J Moss Journal: Circulation Date: 2004-03-01 Impact factor: 29.690
Authors: T Shiga; N Hagiwara; H Ogawa; A Takagi; M Nagashima; T Yamauchi; Y Tsurumi; R Koyanagi; H Kasanuki Journal: Heart Date: 2008-08-26 Impact factor: 5.994