title: [Impact of primary angioplasty on the indication for implantable cardiac defibrillator in patients with myocardial infarction].
abstract: OBJECTIVE
  Implantable cardiac defibrillators (ICD) have been shown to improve survival in patients with myocardial infarctionand LVEF < 0.30 or LVEF < 0.40 + nonsustained ventricular tachycardia + inducible sustained arrhythmias. However, these risk stratification criteria have not been evaluated in patients who are candidates for primary percutaneous transluminal coronary angioplasty (PTCA). The objective of this study was to assess the impact of both strategies on the indication for ICD in a consecutive series of post-infarction patients treated with primary PTCA.
  
  
  METHODS
  One hundred and two consecutive patients with myocardial infarction (80 men, mean age 63.6 11.5 years) included in a single-center-based regional program of primary PTCA were included in the study. A 24-h continuous ECG recording was obtained 2 to 6 weeks after the acute event, and LVEF was determined by 2D-echocardiography one month after the infarct. Patients with nonsustained ventricular tachycardia and LVEF < 0.40 underwent programmed ventricular stimulation using a standard protocol.
  
  
  RESULTS
  Twenty-two patients (21.6%; 95% CI, 13.6-29.6) showed at least one episode of nonsustained ventricular tachycardia in the 24 h recording. Six of them had LVEF < or = 0.40, and sustained ventricular arrhythmia was induced in 2 out of 5. LVEF < or = 0.30 was found in 3 patients, none of whom had nonsustained ventricular tachycardia. Thus, 5 patients had an indication for ICD according to either of the two risk stratification criteria.
  
  
  CONCLUSIONS
  The prevalence of nonsustained ventricular tachycardia in post-infarction patients treated with primary PTCA is high. However, because most of them have preserved ventricular function, primary prevention with an ICD is indicated in approximately 5% of the population.
authors.affiliation: Servicio de Cardiología. Hospital Universitario Virgen de la Arrixaca. Murcia. España.
authors.forename: Josefa
authors.initials: J
authors.lastname: González Carrillo
authors.forename: Arcadi
authors.initials: A
authors.lastname: García Alberola
authors.forename: Daniel
authors.initials: D
authors.lastname: Saura Espín
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrillo Sáez
authors.forename: Ramón
authors.initials: R
authors.lastname: López Palop
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sánchez Muñoz
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez Sánchez
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés Chávarri
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies