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Europace Advance Access published online on January 9, 2009
Europace, doi:10.1093/europace/eun349
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions©oxfordjournals.org.

CLINICAL RESEARCH

Clinical and arrhythmic outcomes after implantation of a defibrillator for primary prevention of sudden death in patients with post-myocardial infarction cardiomyopathy: The Survey to Evaluate Arrhythmia Rate in High-risk MI patients (SEARCH-MI)

Massimo Santini1,*, Maurizio Russo1, Gianluca Botto2, Maurizio Lunati3, Alessandro Proclemer4, Boris Schmidt5, Ali Erdogan6, Erhard Helmling7, Werner Rauhe8, Martin Desaga9, Elisabetta Santi10, Marc Messier11 and Giuseppe Boriani12

1 Cardiovascular Department, San Filippo Neri Hospital, Via Martinotti, 20, 00135 Roma, Italy; 2 S. Anna Hospital, Como, Italy; 3 Niguarda Ca Granda Hospital, Milano, Italy; 4 S. Maria della Misericordia Hospital, Udine, Italy; 5 Universitatsklinikum, Freiburg, Germany; 6 Klinikum der Justus-Liebig-Universitat, Giessen, Germany; 7 Westpfalzklinikum, Kaiserlautern, Germany; 8 S. Maurizio Hospital, Bolzano, Italy; 9 Klinikum Dachau, Dachau, Germany; 10 Medtronic Italia, Rome, Italy; 11 Medtronic Bakken Research Center, Maastricht, The Netherlands; 12 Policlinico S. Orsola-Malpighi, Bologna, Italy

Aims: To evaluate clinical and arrhythmic outcomes in post-infarction cardiomyopathy patients implanted with a defibrillator (ICD) for primary prevention of sudden death.

Methods and results: The SEARCH-MI registry is a European multi-centre, prospective, observational study enrolling patients after myocardial infarction, chronic left ventricular dysfunction and an ICD implanted for primary prevention of sudden death. Data on 556 patients with at least one recorded follow-up are presented. Survey to Evaluate Arrhythmia Rate in High-risk MI (SEARCH-MI) patients were sicker than those enrolled in MADIT-II with higher New York Heart Association class and left bundle branch block. Total mortality was 10.4%. Close to one-third (30%) of patients experienced episodes of sustained ventricular arrhythmia. One-quarter (23%) received at least one appropriate therapy and 10% inappropriate therapy. Gender (25% males vs. 5% females, P = 0.0009) and history of non-sustained ventricular tachycardia (24% with vs. 18% without P = 0.037) were predictive of appropriate ventricular therapy.

Conclusion: SEARCH-MI represents the current clinical management of post-MI patients with left ventricular dysfunction indicated to defibrillator implant for primary prevention. European routine clinical practice was influenced by landmark trials and guidelines which impacted on the implantation of cardiac resynchronization therapy in over 25% of such patients. Non-sustained ventricular tachycardia identifies subjects with a higher incidence of appropriate ICD therapy.

Key Words: Post-infarction cardiomyopathy, Ventricular arrhythmias, Sudden death, Implantable cardioverter defibrillator

* Corresponding author. Tel: +39 06 3306 2294, Fax: +39 06 3306 2489, Email: m.santini{at}rmnet.it

Manuscript submitted 6 June 2008. Accepted after revision 22 October 2008.


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S. Valk and L. Jordaens
Primary prevention: a necessity after myocardial infarction with left ventricular dysfunction
Europace, April 1, 2009; 11(4): 407 - 408.
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