title: Eligibility and utilization of implantable cardioverter-defibrillators in a regional STEMI system.
abstract: BACKGROUND
  Studies have shown mortality benefit for implantable cardioverter-defibrillators (ICDs) in ST-elevation myocardial infarction (STEMI) patients with reduced left ventricular ejection fraction (LVEF), but contemporary eligibility and appropriate utilization of ICDs is unknown.
  
  
  OBJECTIVE
  The purpose of this study was to determine the contemporary eligibility and appropriate utilization of ICDs post-STEMI.
  
  
  METHODS
  Using the prospective Minneapolis Heart Institute regional STEMI registry, LVEF before discharge and at follow-up were stratified into 3 groups: normal (LVEF ≥50%), mildly reduced (LVEF 35%-49%), and severely reduced (LVEF <35%).
  
  
  RESULTS
  From March 2003 to June 2012, 3626 patients were treated. Patients with in-hospital death (n = 187), ICD in place (n = 21), negative cardiac biomarkers (n = 337), and undocumented in-hospital LVEF (n = 9) were excluded, leaving 3072 patients in the final analysis, including 1833 (59.7%) with LVEF ≥50%, 875 (28.5%) with LVEF between 35% and 49%, and 364 (11.8%) with LVEF <35% before hospital discharge. Overall, 1029 patients (33.5%) underwent follow-up echocardiography ≥40 days post-STEMI, including 140 of the 364 patients (38.5%) discharged with LVEF <35%. In total, 73 patients (7.1%) with follow-up echocardiography ≥40 days post-STEMI met criteria for an ICD (68 LVEF ≤30%, 5 LVEF 30%-35%, and New York Heart Association class II or greater). Only 26 of these patients (35.6%) underwent ICD placement within 1 year post-STEMI. Overall, only 10% to 15% of potentially eligible patients had an ICD implemented.
  
  
  CONCLUSIONS
  Rates of ICD implantation in appropriate STEMI patients after 40 days are low. Strategies are needed to identify and expand access to these high-risk patients.
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Johnson
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Ross F
authors.initials: RF
authors.lastname: Garberich
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: William T
authors.initials: WT
authors.lastname: Katsiyiannis
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Jay
authors.initials: J
authors.lastname: Sengupta
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Ankur
authors.initials: A
authors.lastname: Kalra
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hauser
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Lardy
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address: Marc.Newell@allina.com.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Newell
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000379:methods; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods; D004608:Eligibility Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D020380:Needs Assessment; D010351:Patient Discharge / Q000592:standards; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
keywords: Implantable cardioverter-defibrillator; Ischemic cardiomyopathy; Left ventricular ejection fraction; ST-elevation myocardial infarction