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Study Reports Lacking Benefit of ICD Early After Heart Attack

Implantation within a month does not reduce the risk of death

WEDNESDAY, Oct. 7 (HealthDay News) -- An implantable cardioverter-defibrillator (ICD) does not reduce the risk of death when given to high-risk patients within a month after a heart attack, according to a study in the Oct. 8 issue of the New England Journal of Medicine.

Gerhard Steinbeck, M.D., from Ludwig-Maximilians University in Munich, Germany, and colleagues randomly assigned 898 patients with a myocardial infarction who were considered high risk to receive an ICD or medical treatment alone five to 31 days after the attack. Current guidelines do not recommend implantation within 40 days of the attack for prevention of sudden cardiac death.

During a median follow-up of 37 months, the researchers found that the ICD and medical treatment groups had similar overall mortality (hazard ratio, 1.04). Although there were fewer sudden cardiac deaths in the ICD groups (hazard ratio, 0.55), there were more non-sudden cardiac deaths (hazard ratio, 1.92). Hazard ratios were similar regardless of whether patients were enrolled for reduced left ventricular ejection fraction, an elevated heart rate, non-sustained ventricular tachycardia, or a combination.

"Prophylactic ICD therapy did not reduce overall mortality among patients with acute myocardial infarction and clinical features that placed them at increased risk," Steinbeck and colleagues conclude.

The study was supported by grants from Medtronic Bakken Research Center, AstraZeneca, and R. Becker. Many authors reported financial or consulting relationships with medical device companies, and one author is an employee of Medtronic.

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