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Clinical criteria for predicting benefit of ICD/PM in post myocardial infarction patients: an AVID and CAST analysis

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Three clinical factors from the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial—heart failure, left ventricular dysfunction and certain historical features defined a subgroup in which an implantable cardioverter defibrillator (ICD/PM) has a mortality advantage over amiodarone.

Methods

These three factors were jointly evaluated in the AVID cohort with ischemic heart disease (IHD) and the results applied in placebo-treated post-infarction patients in the cardiac arrhythmia suppression trial (CAST).

Results

Similar predictive power was noted in AVID patients with IHD. In CAST the factors defined three groups; one group (5.8%), corresponding to AVID patients that had high risk and benefited from an ICD/PM and another group (17.2%) corresponding to patients in AVID where the risk was moderate and ICD/PM and amiodarone had equal efficacy, demonstrated a two-fold higher risk of sudden arrhythmic than non-arrhythmic death and hence would be expected to benefit from antiarrhythmia therapy. The third group, corresponding to AVID patients with low risk of arrhythmia, demonstrated similar and low risks of sudden arrhythmic and non-arrhythmic death. Thus this group (77%) is unlikely to benefit from indiscriminate antiarrhythmia therapy. Onset of risk of death in CAST patients was offset from randomization by 3 to 6 months.

Conclusions

Readily available clinical criteria identify a small group likely to benefit from an ICD/PM after recent myocardial infarction (MI) and the remainder unlikely to benefit from nonselective ICD/PM therapy. Additional risk stratification should focus on the latter patients and be timed to allow ICD/PM implantation between 2 and 6 months after MI.

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Abbreviations

SAD:

sudden arrhythmic death

MI:

myocardial infarction

ICD/PM:

implantable cardioverter defibrillator/pacemaker

AVID:

Antiarrhythmics Versus Implantable Defibrillators

LVEF:

left ventricular ejection fraction

CAST:

Cardiac Arrhythmia Suppression Trial

IHD:

ischemic heart disease

AAD:

antiarrhythmic drug

VF:

ventricular fibrillation

VT:

ventricular tachycardia

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Author information

Authors and Affiliations

  1. Department of Biostatistics, University of Washington, 1107 NE 45th Ave, room 505, Seattle, WA, 98105, USA

    Alfred P. Hallstrom

  2. Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, USA

    D. George Wyse

  3. The Legacy Health System and Oregon Health and Science University, Portland, OR, USA

    John McAnulty

Authors
  1. Alfred P. Hallstrom
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  2. D. George Wyse
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  3. John McAnulty
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Consortia

for the CAST and AVID Investigators

Corresponding author

Correspondence to Alfred P. Hallstrom.

Additional information

CAST and AVID were conducted under funding from NHLBI. Partial support for the current analysis is from St. Jude Medical and the University of Washington.

Clinical Trail Registration Number: AVID and CAST were both completed prior to when clinical trial registration was available or required.

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Hallstrom, A.P., Wyse, D.G., McAnulty, J. et al. Clinical criteria for predicting benefit of ICD/PM in post myocardial infarction patients: an AVID and CAST analysis. J Interv Card Electrophysiol 23, 159–166 (2008). https://doi.org/10.1007/s10840-008-9304-4

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  • DOI: https://doi.org/10.1007/s10840-008-9304-4

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