title: Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction.
abstract: BACKGROUND
  Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in patients early after myocardial infarction is unknown.
  
  
  METHODS
  We conducted the Defibrillator in Acute Myocardial Infarction Trial, a randomized, open-label comparison of ICD therapy (in 332 patients) and no ICD therapy (in 342 patients) 6 to 40 days after a myocardial infarction. We enrolled patients who had reduced left ventricular function (left ventricular ejection fraction, 0.35 or less) and impaired cardiac autonomic function (manifested as depressed heart-rate variability or an elevated average 24-hour heart rate on Holter monitoring). The primary outcome was mortality from any cause. Death from arrhythmia was a predefined secondary outcome.
  
  
  RESULTS
  During a mean (+/-SD) follow-up period of 30+/-13 months, there was no difference in overall mortality between the two treatment groups: of the 120 patients who died, 62 were in the ICD group and 58 in the control group (hazard ratio for death in the ICD group, 1.08; 95 percent confidence interval, 0.76 to 1.55; P=0.66). There were 12 deaths due to arrhythmia in the ICD group, as compared with 29 in the control group (hazard ratio in the ICD group, 0.42; 95 percent confidence interval, 0.22 to 0.83; P=0.009). In contrast, there were 50 deaths from nonarrhythmic causes in the ICD group and 29 in the control group (hazard ratio in the ICD group, 1.75; 95 percent confidence interval, 1.11 to 2.76; P=0.02).
  
  
  CONCLUSIONS
  Prophylactic ICD therapy does not reduce overall mortality in high-risk patients who have recently had a myocardial infarction. Although ICD therapy was associated with a reduction in the rate of death due to arrhythmia, that was offset by an increase in the rate of death from nonarrhythmic causes.
authors.affiliation: Department of Medicine, Division of Cardiology, J.W. Goethe University, Frankfurt, Germany. hohnloser@em.uni-frankfurt.de
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Robin S
authors.initials: RS
authors.lastname: Roberts
authors.forename: John R
authors.initials: JR
authors.lastname: Hampton
authors.forename: Robert
authors.initials: R
authors.lastname: Hatala
authors.forename: Eric
authors.initials: E
authors.lastname: Fain
authors.forename: Michael
authors.initials: M
authors.lastname: Gent
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012306:Risk; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000209:etiology