Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death after myocardial infarction: implications of international guidelines.
OBJECTIVE
To estimate the proportion of patients eligible for implantable cardioverter defibrillator (ICD) therapy for the primary prevention of sudden cardiac death after a myocardial infarction (MI), according to the current guidelines.


METHODS
Eligibility was assessed retrospectively at 6 weeks in 513 post-MI survivors (age 66 +/- 13 years, left ventricular ejection fraction 48.2 +/- 17%) on the basis of an electrocardiogram and an echocardiogram.


RESULTS
LVEF was < or = 40% in 37% and < or = 35% in 30%, and QRS duration was <120 ms in 89% and > or =120 ms in 11% of patients. The proportion of post-MI patients meeting the criteria set by guidelines were 37% for 2006 American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) 26.5% for 2008 ACC/AHA/Canadian Heart Rhythm Society 16.3% for 2005 US Centers for Medicare and Medicaid Services (CMS), and 5.8% for the 2006 United Kingdom (UK) National Institute of Clinical Excellence (NICE). According to 2005 CMS and 2006 UK-NICE guidelines, Holter monitoring was required in 7% and 18%, respectively. For the United States (700,000 MI in 2006), the 2006 ACC/AHA/ESC guidelines equate to 216,783 ICD implantations/year. For UK (60,499 MI in 2006), the 2006 NICE guidelines equate to 2,941 ICD implantations, 10,488 Holter studies, and 1,065 VT induction tests/year.


CONCLUSIONS
Current ICD therapy guidelines for primary prevention of SCD post-MI demand a substantial increase in service provision worldwide.
Foley
Paul W X
PW
University of Birmingham, Good Hope Hospital, Sutton Coldfield, UK.
Addison
Clara E
CE
Whinney
Stephanie B
SB
Patel
Kiran
K
Cunningham
David
D
Frenneaux
Michael P
MP
Leyva
Francisco
F
D000368:Aged; D044362:Australasia; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000592:standards* / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control*; D009656:North America / Q000453:epidemiology; D017410:Practice Guidelines as Topic