News | March 04, 2011

Study: ICD Therapy Beneficial Regardless of Time From Heart Attack

March 4, 2011 – According to a retrospective sub-study of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), there is no evidence that implantable cardioverter defibrillator (ICD) benefit varies with time from myocardial infarction (MI) to device implantation. Accordingly, single lead ICD benefit is not restricted to patients with a remote MI (more than 18 months).

The study, published in HeartRhythm, the official journal of the Heart Rhythm Society, suggests that ICD therapy post-MI decreases the chances of SCD starting immediately after the post-infarct period of up to 40 days.

In SCD-HeFT, 2,521 patients across the United States, Canada and New Zealand were randomly assigned to single lead, shock-only ICD therapy, amiodarone or placebo (double blind). The trial analyzed the use of ICDs in patients who experienced MI, yet had no previous life-threatening arrhythmia. The purpose was to determine the efficacy of ICDs as a primary prevention therapy for patients with moderate heart failure. It found that ICD therapy significantly decreased the relative risk of mortality by 23 percent.

The retrospective sub-study, led by Jonathan Piccini, M.D., MHS, analyzed the outcomes of ICD therapy in post-MI patients to determine whether mortality benefit varied as a function of time. Data from 712 patients were analyzed and divided into tertiles based on the amount of time that had passed between MI and the implantation of a single-lead ICD.

Analysis revealed that patients randomized to ICD therapy (vs. placebo) were less likely to experience SCD in all three groups: 6.2 percent versus 14.2 percent within the first 2.11 years, 5.8 percent versus 10.3 percent between 2.11 and 7.31 years, and 2.5 percent versus 17.4 percent over 7.31 years. A sensitivity analysis was also conducted and revealed that there was no evidence that ICD benefit varied between implantation within the first 18 months or after.

“It is widely known that the risk of SCD is most common in people immediately following a heart attack, yet some evidence suggests that the benefits of ICD therapy may be restricted to those patients who are more than a year after their MI,” Piccini said. “However, the SCD-HeFT results show that the benefit of single lead, conservatively programmed ICD therapy is not limited to those patients remote from a myocardial infarction. Ensuring that eligible patients receive primary prevention defibrillator therapy is likely to be more important than when the device is implanted, outside of 40 days.”

Although future, prospective trials are needed, the analysis has shown there is no evidence that ICD benefit varied with time from MI to implantation. Therefore, ICD implantation, at least as implemented in SCD-HeFT, should not be restricted to patients with remote MI (more than 18 months), as previously suggested. The differences in outcome between SCD-HeFT and prior studies are not clear but the use of a simpler more conservatively programmed ICD may be responsible.

There are also some important limitations to the SCD-HeFT analysis. Patients with MI, unstable angina, or coronary revascularization within the last 30 days were not eligible for enrollment in SCD-HeFT. Additionally, only 10 percent of the patients in the SCD-HeFT analysis were within six months of their most recent MI.

For more information:

Related Content

New FDA Proposed Rule Alters Informed Consent for Clinical Studies
News | Cardiovascular Clinical Studies | November 19, 2018
The U.S. Food and Drug Administration (FDA) is proposing to add an exception to informed consent requirements for...
A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development. #SCAI, #SCAI2018

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development.  

Feature | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 – New clinical evidance shows common therapy options for psoriasis (PSO), a chronic inflammatory skin di
Intravenous Drug Use is Causing Rise in Heart Valve Infections, Healthcare Costs. #SCAI, #SCAI2018
News | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 — The opioid drug epidemic is impacting cardiology, with a new study finding the number of patients hosp
Patient Enrollment Completed in U.S. IDE Study of THERMOCOOL SMARTTOUCH SF Catheter
News | Cardiovascular Clinical Studies | March 15, 2018
March 15, 2018 –  Johnson & Johnson Medical Devices Companies announced today that Biosense Webster, Inc., who wo
Lexington Begins HeartSentry Clinical Trial
News | Cardiovascular Clinical Studies | February 20, 2018
February 20, 2018 – Lexington Biosciences, Inc., a development-stage medical device company, announced the commenceme
Endologix Completes Patient Enrollment in the ELEVATE IDE Clinical Study
News | Cardiovascular Clinical Studies | February 06, 2018
February 6, 2018 – Endologix, a developer and marketer of treatments for aortic disorders, announced the completion o
12-Month Results from Veryan Medical's MIMICS-2 IDE Study Presented at LINC
News | Cardiovascular Clinical Studies | February 01, 2018
February 1, 2018 – Thomas Zeller (Bad Krozingen, Germany) presented the 12-month results from Veryan Medical’s MIMICS
LimFlow Completes U.S. Feasibility Study Enrollment, Receives FDA Device Status
News | Cardiovascular Clinical Studies | February 01, 2018
February 1, 2018 –  LimFlow SA, developer of minimally-inv
ESC 2017 late breaking trial hot line study presentations.
News | Cardiovascular Clinical Studies | September 12, 2017
September 12, 2017 – The European Society of Cardiology (ESC) Congress 2017 includes several Hot Line Late-breaking C
U.K., NHS studies, weekend effect, hospital admission, atrial fibrillation, heart failure
News | Cardiovascular Clinical Studies | June 28, 2016
New research shows patients admitted to National Health Service (NHS) hospitals in the United Kingdom for atrial...
Overlay Init