TY - JOUR
T1 - Eligibility and utilization of implantable cardioverter-defibrillators in a regional STEMI system
AU - Johnson, Benjamin K.
AU - Garberich, Ross F.
AU - Henry, Timothy D.
AU - Katsiyiannis, William T.
AU - Sengupta, Jay
AU - Kalra, Ankur
AU - Hauser, Robert G.
AU - Lardy, Meghan E.
AU - Newell, Marc C.
N1 - Funding Information:
This research was supported by the Minneapolis Heart Institute Foundation.
Publisher Copyright:
© 2016 Heart Rhythm Society.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - 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.
AB - 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.
KW - Implantable cardioverter-defibrillator
KW - Ischemic cardiomyopathy
KW - Left ventricular ejection fraction
KW - ST-elevation myocardial infarction
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U2 - 10.1016/j.hrthm.2015.10.019
DO - 10.1016/j.hrthm.2015.10.019
M3 - Article
C2 - 26576706
AN - SCOPUS:84955755805
SN - 1547-5271
VL - 13
SP - 538
EP - 546
JO - Heart Rhythm
JF - Heart Rhythm
IS - 2
ER -