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Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis.

Publication ,  Journal Article
Piccini, JP; Al-Khatib, SM; Myers, ER; Anstrom, KJ; Buxton, AE; Peterson, ED; Sanders, GD
Published in: J Cardiovasc Electrophysiol
July 2010

BACKGROUND: The optimal timing of implantable cardioverter defibrillator (ICD) placement for the primary prevention of sudden cardiac death after myocardial infarction (MI) remains unknown. METHODS AND RESULTS: We developed a Markov model to investigate the optimal timing of ICD implantation after MI (no ICD, ICD at 60 days, 6 months, and 1 year) in patients who meet current guidelines. Estimates of arrhythmic death (baseline risk 6%, range 1-20% per year), nonarrhythmic death, and ICD efficacy were based upon MADIT-II and other contemporary post-MI clinical trials. We used both deterministic and stochastic modeling processes in our analysis. After 10 years follow-up, the baseline probability of survival was higher in those treated with ICD implantation versus not (42% vs 30%, P < 0.001). Survival was highest with ICD implantation at 60 days versus 6 months versus 1 year: 42.4%, 42.3%, and 42.0% (P = 0.0028). ICD implantation at 60 days provided a mean incremental survival of 0.28 months and 0.84 months per patient (compared with implantation at 6 months and 1 year). In sensitivity analyses, patients' competing risk for nonarrhythmic death was the primary determinant of benefit from ICD implantation. Overall, ICD implantation at 60 days resulted in the greatest life expectancy over a wide range of plausible nonarrhythmic and arrhythmic death rates. CONCLUSIONS: The benefits of early ICD implantation are modest when compared with delayed implantation at 6 months/1 year. Our results suggest that making sure a patient receives an ICD, when appropriate, may be more important than the timing of the implantation procedure.

Duke Scholars

Published In

J Cardiovasc Electrophysiol

DOI

EISSN

1540-8167

Publication Date

July 2010

Volume

21

Issue

7

Start / End Page

791 / 798

Location

United States

Related Subject Headings

  • Time Factors
  • Stochastic Processes
  • Risk Factors
  • Risk Assessment
  • Reproducibility of Results
  • Practice Guidelines as Topic
  • Patient Selection
  • Myocardial Infarction
  • Monte Carlo Method
  • Markov Chains
 

Citation

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MLA
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Piccini, J. P., Al-Khatib, S. M., Myers, E. R., Anstrom, K. J., Buxton, A. E., Peterson, E. D., & Sanders, G. D. (2010). Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis. J Cardiovasc Electrophysiol, 21(7), 791–798. https://doi.org/10.1111/j.1540-8167.2009.01696.x
Piccini, Jonathan P., Sana M. Al-Khatib, Evan R. Myers, Kevin J. Anstrom, Alfred E. Buxton, Eric D. Peterson, and Gillian D. Sanders. “Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis.J Cardiovasc Electrophysiol 21, no. 7 (July 2010): 791–98. https://doi.org/10.1111/j.1540-8167.2009.01696.x.
Piccini JP, Al-Khatib SM, Myers ER, Anstrom KJ, Buxton AE, Peterson ED, et al. Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis. J Cardiovasc Electrophysiol. 2010 Jul;21(7):791–8.
Piccini, Jonathan P., et al. “Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis.J Cardiovasc Electrophysiol, vol. 21, no. 7, July 2010, pp. 791–98. Pubmed, doi:10.1111/j.1540-8167.2009.01696.x.
Piccini JP, Al-Khatib SM, Myers ER, Anstrom KJ, Buxton AE, Peterson ED, Sanders GD. Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis. J Cardiovasc Electrophysiol. 2010 Jul;21(7):791–798.
Journal cover image

Published In

J Cardiovasc Electrophysiol

DOI

EISSN

1540-8167

Publication Date

July 2010

Volume

21

Issue

7

Start / End Page

791 / 798

Location

United States

Related Subject Headings

  • Time Factors
  • Stochastic Processes
  • Risk Factors
  • Risk Assessment
  • Reproducibility of Results
  • Practice Guidelines as Topic
  • Patient Selection
  • Myocardial Infarction
  • Monte Carlo Method
  • Markov Chains