Long-Term Outcome of the Randomized DAPA Trial.

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• The DAPA trial investigated the survival benefit of prophylactic implantable cardioverter-defibrillators (ICDs) in high-risk patients post-ST-segment-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).
• High-risk criteria included left ventricular ejection fraction <30%, primary ventricular fibrillation, Killip class ≥2, or TIMI flow <3 after primary PCI.

Purpose of the Study:

• To evaluate the efficacy of early prophylactic ICD implantation in reducing all-cause mortality in high-risk STEMI patients undergoing primary PCI.
• To assess the long-term impact of ICDs on total and cardiac mortality in this patient population.

Main Methods:

• A randomized, multicenter, controlled trial comparing ICD implantation versus conventional medical therapy.
• 266 high-risk STEMI patients were enrolled, with ICDs implanted 30-60 days post-MI.
• The primary endpoint was all-cause mortality at 3 years, with additional long-term survival assessment.

Main Results:

• After 3 years, all-cause mortality was significantly lower in the ICD group (5% vs. 13%).
• Over a median 9-year follow-up, total mortality (18% vs. 38%) and cardiac mortality were significantly reduced with ICDs.
• Appropriate ICD therapy was observed in 9 patients within 3 years.

Conclusions:

• Despite premature termination and underpowering, the DAPA trial suggests that early prophylactic ICD implantation reduces total and cardiac mortality in high-risk STEMI patients treated with primary PCI.
• The findings support the use of ICDs in selected high-risk post-MI patients to improve long-term survival.