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(Circulation. 1996;94:3052-3053.)
© 1996 American Heart Association, Inc.

Articles

Meeting Highlights

XVIIIth Congress of the European Society of Cardiology, August 25-29, 1996

Robin Fox, FRCP

From the St Luke's Episcopal Hospital/Texas Heart Institute

Reprint requests to Dr Robin Fox, c/o Circulation, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, Room B524 (MC1-267), Houston, TX 77030-2697.

	Introduction

 
How should we reduce deaths from ischemic heart disease? At the XVIIIth Congress of the European Society of Cardiology, the most radical proposal was for a general redistribution of income to narrow the gap between richest and poorest—the example before us being Japan, with its low rate of heart disease. This idea generated barely a flicker of interest. In Europe, as in the United States, most cardiologists have decided that their preventive activities should be focused on patients and their families; population aspects are for others to deal with. But even at patient level, the average physician offers scant support on matters such as diet, exercise, and smoking. Acute interventions generate more enthusiasm, and the presentation that caused the biggest stir at the Congress was a report from Dr Arthur J. Moss (University of Rochester Medical Center, Rochester, NY) on the Multicenter Automatic Defibrillator Implantation Trial.

	MADIT

 
MADIT is the first large randomized study comparing implantable cardioverter-defibrillators (ICDs) with conventional medical treatment. All the patients had had myocardial infarction and were at high risk of sudden cardiac death as judged by clinical features and electrophysiological testing—inducibility of monomorphic ventricular tachycardia not suppressible by standard agents. Randomization was to ICD (CPI/Guidant) or conventional treatment, usually amiodarone. The investigators used sequential analysis, and the trial was stopped after recruitment of 196 patients, when there was a clear advantage for the ICD group—only 15 of 95 had died, compared with 39 of 101 on conventional therapy (a 54% reduction in all-cause mortality).

Extrapolating from . . . [Full Text of this Article]