Structured care for patients after acute myocardial infarction: sudden cardiac death prevention--data from the Leiden
Jael Z Atary1, C Jan Willem Borleffs, Su San Liem
1Department of Cardiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands.
Insights
Aggressive treatment following acute myocardial infarction (AMI) significantly reduces the need for implantable cardioverter defibrillators (ICDs). This study found only 6% of AMI patients met ICD criteria within a year under an intensive protocol.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) management aims to prevent sudden cardiac death (SCD).
- Implantable cardioverter defibrillators (ICDs) are used for primary prevention of SCD in select post-MI patients.
- Aggressive treatment protocols may influence the number of patients eligible for ICD implantation.
Purpose of the Study:
- To determine the proportion of AMI patients meeting ICD implantation criteria within one year.
- To evaluate the impact of an aggressive treatment protocol (MISSION!) on ICD candidacy.
- To assess the long-term outcomes, including appropriate ICD therapy and SCD, in this patient cohort.
Main Methods:
- Analysis of 676 consecutive AMI patients treated under the MISSION! protocol.
- Assessment of left ventricular ejection fraction (LVEF) at 3 months post-MI.
- Evaluation of patient characteristics, infarction extent (peak troponin T, LAD involvement), and ICD implantation criteria.
Main Results:
- Only 6% (39 patients) met ICD implantation criteria within one year post-MI.
- Patients meeting criteria had more extensive infarctions (higher peak troponin T, LAD-related infarctions).
- Cumulative appropriate ICD therapy rate was 15% at 3 years; no SCD occurred.
Conclusions:
- Intensive, standardized treatment protocols for AMI patients lead to a low rate of prophylactic ICD candidacy.
- An integrated protocol of aggressive reperfusion, optimal medication, and risk stratification can manage ICD implantation rates.
- This approach supports effective SCD prevention while maintaining manageable ICD utilization.
Aims:
To assess the number of patients in daily clinical practice that meets criteria for implantation of an implantable cardioverter defibrillator (ICD) following acute myocardial infarction (AMI) when treated according to an aggressive treatment protocol.
Methods And Results:
Patients were treated according to the MISSION! protocol. The protocol encompasses pre-hospital, in-hospital, and outpatient clinical framework for the acute and chronic treatment of AMI patients and the decision making regarding primary prevention of sudden cardiac death (SCD). A total of 676 consecutive AMI patients (78% male, mean age 59 +/- 12 years) treated according to the MISSION! protocol were included in this analysis. Left ventricular ejection fraction at 3 months was 54 +/- 10%. Only 39 (6%) patients met criteria for implantation of an ICD <1 year post-MI. These patients suffered more extensive infarctions as indicated by higher peak troponin T values (mean 14.5 +/- 8.3 vs. 6.5 +/- 14.7 microg/L; P < 0.001) and had more left anterior descending artery related infarctions (79 vs. 46%; P < 0.001). Cumulative first appropriate therapy rate was 15% at 3 years follow-up. No SCD was observed in the study population.
Conclusion:
Aggressive treatment of AMI patients and close monitoring after the index event according to a standardized protocol, results in only a small number of patients becoming candidate for prophylactic ICD implantation. An easy-to-use protocol combining aggressive reperfusion, optimal medication, and a risk stratification algorithm tailored to fit within routine practice may help to maintain ICD implantation rates within manageable proportions.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
07:40Protection of H9c2 Myocardial Cells from Oxidative Stress by Crocetin via PINK1/Parkin Pathway-Mediated Mitophagy
Published on: May 26, 2023
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy