Abstract 17745: Underutilization of Implantable Cardioverter-Defibrillators in Appropriate Patients in a Regional ST-Elevation Myocardial Infarction System
Background: Previous studies have shown a clear mortality benefit in placing implantable cardioverter-defibrillators (ICD) in patients with severely reduced (≤35%) left ventricular ejection fraction (LVEF) after 40 days. Negative remodeling and left ventricular dilation, which lead to reduction in LVEF, are also known phenomenon post infarction. Limited data is available to evaluate the use of ICDs in appropriate patients in the real world.
Methods: The Minneapolis Heart Institute “Level I STEMI” program is a regional STEMI network that was instituted in March 2003, and follows patients prospectively, with follow-up data to five years. The patients who survive to hospital discharge are followed for their LVEF at hospital discharge. Follow-up LVEF assessment (by echocardiography) is recommended at 40 days and 1 year.
Results: From March 2003-March 2013, 3,626 patients have been enrolled in the Level I STEMI network database. In-hospital mortality was 5.2%. LVEF assessment was performed within 10 days of infarction on all patients, follow up LVEF assessment was performed on 45% of patients (n=1577). Based on first available LVEF data after 40 days, 87 patients met criteria for ICD placement based on current guidelines. Twenty-seven patients (31%) received ICD placement.
Conclusions: Rates of ICD use in appropriate STEMI patients after 40 days is low. Further strategies are needed to expand access to such patients.
- Implantable cardioconvert defibrillator
- Myocardial infarction, STEMI
- Ventricular function
- Ejection fraction
- © 2013 by American Heart Association, Inc.