title: Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators.
abstract: BACKGROUND
  Unsustained ventricular tachycardia in patients with previous myocardial infarction and left ventricular dysfunction is associated with a two-year mortality rate of about 30 percent. We studied whether prophylactic therapy with an implanted cardioverter-defibrillator, as compared with conventional medical therapy, would improve survival in this high-risk group of patients.
  
  
  METHODS
  Over the course of five years, 196 patients in New York Heart Association functional class I, II, or III with prior myocardial infarction; a left ventricular ejection fraction < or = 0.35; a documented episode of asymptomatic unsustained ventricular tachycardia; and inducible, nonsuppressible ventricular tachyarrhythmia on electrophysiologic study were randomly assigned to receive an implanted defibrillator (n = 95) or conventional medical therapy (n=101). We used a two-sided sequential design with death from any cause as the end point.
  
  
  RESULTS
  The base-line characteristics of the two treatment groups were similar. During an average follow-up of 27 months, there were 15 deaths in the defibrillator group (11 from cardiac causes) and 39 deaths in the conventional-therapy group (27 from cardiac causes) (hazard ratio for overall mortality, 0.46; 95 percent confidence interval, 0.26 to 0.82; P=0.009). There was no evidence that amiodarone, beta-blockers, or any other antiarrhythmic therapy had a significant influence on the observed hazard ratio.
  
  
  CONCLUSIONS
  In patients with a prior myocardial infarction who are at high risk for ventricular tachyarrhythmia, prophylactic therapy with an implanted defibrillator leads to improved survival as compared with conventional medical therapy.
authors.affiliation: Department of Medicine, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Moss
authors.forename: W J
authors.initials: WJ
authors.lastname: Hall
authors.forename: D S
authors.initials: DS
authors.lastname: Cannom
authors.forename: J P
authors.initials: JP
authors.lastname: Daubert
authors.forename: S L
authors.initials: SL
authors.lastname: Higgins
authors.forename: H
authors.initials: H
authors.lastname: Klein
authors.forename: J H
authors.initials: JH
authors.lastname: Levine
authors.forename: S
authors.initials: S
authors.lastname: Saksena
authors.forename: A L
authors.initials: AL
authors.lastname: Waldo
authors.forename: D
authors.initials: D
authors.lastname: Wilber
authors.forename: M W
authors.initials: MW
authors.lastname: Brown
authors.forename: M
authors.initials: M
authors.lastname: Heo
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000150:complications / Q000401:mortality*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000150:complications*
chemical_list: D000889:Anti-Arrhythmia Agents