title: Relation between time from myocardial infarction to enrolment and patient outcomes in the Multicenter UnSustained Tachycardia Trial.
abstract: OBJECTIVE
  We sought to assess the relation between time from myocardial infarction (MI) to enrolment and patient outcomes and to examine the association between these outcomes and implantable cardioverter defibrillator (ICD) therapy.
  
  
  RESULTS
  We analysed the Multicenter UnSustained Tachycardia Trial database (n = 1650). In examining all endpoints, Cox proportional hazards models were used to adjust for potential confounders. There was no significant association between time from MI to enrolment and any of the outcomes (P > 0.1). Inducibility by an electrophysiology study (EPS) was associated with a higher risk of arrhythmic death or cardiac arrest [adjusted hazard ratio (HR) 2.51; 95% confidence interval (CI) 1.64-3.84] and all-cause death (adjusted HR 1.45; 95% CI 1.04-2.03) only in patients who had an MI <or=6 months prior to enrolment. ICD therapy was associated with improved survival in patients who had an MI <or=6 months (adjusted HR 0.35; 95% CI 0.17-0.74) and >6 months before enrolment (adjusted HR 0.34; 95% CI 0.21-0.54).
  
  
  CONCLUSIONS
  The risk of arrhythmic death or cardiac arrest and all-cause death did not vary as a function of time from the most recent MI to enrolment. Inducibility by an EPS was associated with worse outcomes only in patients with an MI <or=6 months prior to enrolment. Although ICD therapy was associated with improved survival regardless of the time from MI to enrolment, this finding needs to be verified by a randomized clinical trial.
authors.affiliation: 1 Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.forename: Gail
authors.initials: G
authors.lastname: Hafley
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Buxton
mesh_terms: D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D013610:Tachycardia / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome
references.citation: J Am Coll Cardiol. 2008 Sep 30;52(14):1111-21
references.pmid: 18804736
references.citation: N Engl J Med. 1996 Dec 26;335(26):1933-40
references.pmid: 8960472
references.citation: J Am Coll Cardiol. 2006 Jan 3;47(1):98-107
references.pmid: 16386671
references.citation: N Engl J Med. 1999 Dec 16;341(25):1882-90
references.pmid: 10601507
references.citation: J Am Coll Cardiol. 2003 Aug 20;42(4):652-8
references.pmid: 12932596
references.citation: N Engl J Med. 2002 Mar 21;346(12):877-83
references.pmid: 11907286
references.citation: Circulation. 2008 May 27;117(21):e350-408
references.pmid: 18483207
references.citation: Circulation. 2004 Mar 9;109(9):1082-4
references.pmid: 14993128
references.citation: N Engl J Med. 2004 Dec 9;351(24):2481-8
references.pmid: 15590950
references.citation: N Engl J Med. 2005 Jun 23;352(25):2581-8
references.pmid: 15972864
references.citation: N Engl J Med. 2009 Oct 8;361(15):1427-36
references.pmid: 19812399
references.citation: N Engl J Med. 2005 Jan 20;352(3):225-37
references.pmid: 15659722