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

Autor:	Johnson BK; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Hennepin County Medical Center, Minneapolis, Minnesota., Garberich RF; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota., Henry TD; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Heart Institute, Los Angeles, California., Katsiyiannis WT; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota., Sengupta J; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota., Kalra A; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota., Hauser RG; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota., Lardy ME; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota., Newell MC; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address: Marc.Newell@allina.com.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2016 Feb; Vol. 13 (2), pp. 538-46. Date of Electronic Publication: 2015 Oct 13.
DOI:	10.1016/j.hrthm.2015.10.019
Abstrakt:	Background: 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. Objective: The purpose of this study was to determine the contemporary eligibility and appropriate utilization of ICDs post-STEMI. Methods: 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%-49%), and severely reduced (LVEF <35%). Results: 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%-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. Conclusion: 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. (Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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