Structured care for patients after acute myocardial infarction: sudden cardiac death prevention--data from the Leiden MISSION! AMI study.
OBJECTIVE
To assess the number of patients in daily clinical practice that meets criteria for implantation of an implantable cardioverter defibrillator (ICD) following acute myocardial infarction (AMI) when treated according to an aggressive treatment protocol.


RESULTS
Patients were treated according to the MISSION! protocol. The protocol encompasses pre-hospital, in-hospital, and outpatient clinical framework for the acute and chronic treatment of AMI patients and the decision making regarding primary prevention of sudden cardiac death (SCD). A total of 676 consecutive AMI patients (78% male, mean age 59 +/- 12 years) treated according to the MISSION! protocol were included in this analysis. Left ventricular ejection fraction at 3 months was 54 +/- 10%. Only 39 (6%) patients met criteria for implantation of an ICD <1 year post-MI. These patients suffered more extensive infarctions as indicated by higher peak troponin T values (mean 14.5 +/- 8.3 vs. 6.5 +/- 14.7 microg/L; P < 0.001) and had more left anterior descending artery related infarctions (79 vs. 46%; P < 0.001). Cumulative first appropriate therapy rate was 15% at 3 years follow-up. No SCD was observed in the study population.


CONCLUSIONS
Aggressive treatment of AMI patients and close monitoring after the index event according to a standardized protocol, results in only a small number of patients becoming candidate for prophylactic ICD implantation. An easy-to-use protocol combining aggressive reperfusion, optimal medication, and a risk stratification algorithm tailored to fit within routine practice may help to maintain ICD implantation rates within manageable proportions.
Atary
Jael Z
JZ
Department of Cardiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands.
Borleffs
C Jan Willem
CJ
Liem
Su San
SS
Bax
Jeroen J
JJ
van der Hoeven
Bas L
BL
Bootsma
Marianne
M
van der Wall
Ernst E
EE
van Erven
Lieselot
L
Schalij
Martin J
MJ
D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D018579:Patient Selection; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left
D020107:Troponin T