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Prof. Heinz Voeller
Prof. Panagiotis Vardas,
Presenter | see Discussant report
Voeller, Heinz, FESC (Germany)
List of Authors: H. Völler, W. Kamke, H. U. Klein, M. Block, R. Reibis, S. Treusch, K. Contzen, K. Wegscheider Abstract: Current guidelines recommend implantable cardioverter-defibrillator (ICD) therapy for primary prevention of sudden cardiac death (SCD) in patients with reduced left ventricular function (LVEF = 30-35%) more than 40 days after myocardial infarction (MI). The aim of the prospective Prevention of Sudden Cardiac Death II (PreSCD II) registry was to investigate daily practice of ICD therapy in post-MI patients and to evaluate their long-term survival. Methods: 10,612 consecutive post MI patients (61±12 years, 76% male) were enrolled in 19 cardiac rehabilitation (CR) centers in Germany from December 2002 to May 2005. All patients with LVEF = 40% together with a random subsample with preserved left ventricular function (LVEF > 40%) were followed for 36 months. Logistic regression modeling was applied to characterize patients with ICD therapy. Cox proportional hazard models with ICD therapy as time-dependent covariate were used to study overall survival. Results: 77.4% of all patients were enrolled within 60 days, 10.7% more than one year after MI. 269 patients (2.5%, Group 1) had LVEF = 30% and 727 patients (6.9%, Group 2) had LVEF 31-40%. Follow-up was performed in a total of 2,058 patients, 259 in Group 1, 693 in Group 2 and 1,106 in Group 3 (LVEF > 40%). Seventy-five patients received an ICD within four months after risk stratification, 57 (22%) in Group 1 and 15 (2.2%) in Group 2. After 36 months 142 (6.9%) patients had received an ICD, 47% of them within one year after their index MI. ICD implantation was mainly driven by LVEF = 30% and to a lesser extent by non-sustained ventricular tachycardia, prior syncope, NYHA II-IV, prolonged QRS, renal insufficiency, and more remote index MI. ICD patients had an adjusted 44% lower mortality (HR 0. 56, 95% CI 0.32-1.01; p=0.053) than comparable patients without ICD therapy. There was a significant trend towards lower mortality of ICD recipients if the device was implanted in the remote phase of MI (p<0.001). Conclusions: The PreSCD II registry showed a low prevalence of patients with reduced left ventricular function after MI. Few patients with guideline-based ICD indication received ICD therapy. Mortality was reduced if an ICD was implanted late after MI.
Discussant | see Presenter abstract
Vardas, Panagiotis FESC (Greece)
Access the slides from the discussant
Prevention of Sudden Cardiac Death in Post Myocardial Infarction Patients: Risk Stratification, ICD Therapy Penetration and Related Longterm Outcome: Final Results of the German PreSCD II Registry
This congress report accompanies a presentation given at the ESC Congress 2009. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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