| Autor: |
Raviele, A, Bongiorni, Mg, Brignole, M, Cappato, R, Capucci, A, Gaita, Fiorenzo, Gulizia, M, Mangiameli, S, Montenero, As, Pedretti, Rf, Uriarte, Ja, Sermasi, S, Nisam, S. |
| Rok vydání: |
2005 |
| Předmět: |
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| Zdroj: |
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 7(4) |
| ISSN: |
1099-5129 |
| Popis: |
This multicentre prospective randomised trial was undertaken to evaluate the usefulness of an electrophysiological study (EPS)-guided/implantable cardioverter defibrillator (ICD) strategy in patients at high risk of sudden death (SD) early after myocardial infarction (MI). Previous studies have shown the benefits of such a strategy only in high-risk patients late after MI.We enrolled 143 survivors of acute MI (1 month) with left ventricular ejection fractionor = 35% and either frequent (or =10/h) premature ventricular complexes (PVCs), or depressed heart rate variability (SDNN70 ms) or abnormal signal-averaged ECG, who were able to tolerate optimised beta-blocker therapy (68 +/- 40 mg/day of metoprolol). Of these, 138 were randomised, in a 2:3 ratio, to two therapeutic strategies: conventional (CONV) strategy (n = 59) or EPS-guided/ICD strategy (n = 79). The latter resulted in ICD implantation in 24 inducible patients and in CONV therapy in the remaining 55. During a mean follow-up of 540 +/- 378 days, 26 patients (19%) died: nine (6.5%) SD, nine (6.5%) non-SD, and four (3%) non-cardiac death; in four patients (3%) the cause of death was unknown. The actuarial overall mortality for the CONV and EPS-guided/ICD arms was 18% vs 14% after 1 year and 29.5% vs 20% after 2 years, respectively (P = 0.3 and 0.2).Despite optimal therapy, mortality remains significant in high-risk patients following MI. Although there is a trend in favour of EPS-guided/ICD, our data are insufficient to demonstrate a survival benefit of this strategy early after MI. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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