PreSCD II registry: ICD implantation after MI associated with reduced mortality

The registry also revealed that few patients with an indication for ICD therapy received an ICD.

European Society of Cardiology Congress 2009

Results from a German implantable cardioverter defibrillator registry suggested that few patients with a guideline-based indication for an ICD receive one, and that mortality was reduced when an ICD was implanted late after MI.

Researchers for the PreSCD II registry enrolled 10,612 consecutive patients who had MI in 19 German rehabilitation centers. The researchers used logistic regression modeling to characterize the patients with ICDs, and Cox proportional hazard models to evaluate overall survival. Follow-up was performed in a total of 2,058 patients stratified according to left ventricular ejection fraction, with 259 patients having LVEF <30%, 693 having LVEF between 31% and 40%, and 1,106 having LVEF >40%.

According to the registry results, there was a low rate of post-MI patients with severely reduced LVEF <30% (2.5%, 269 patients). Patients implanted with an ICD to protect against sudden cardiac death within one month or more following MI showed a 44% reduction in mortality compared with those who did not receive an ICD (P=.053). In patients with an ICD and LVEF <30%, mortality declined by 47% (P=.07). The researchers also reported a trend towards reduced mortality in patients who were implanted with ICDs in the remote phase of MI (P<.001).

“The PreSCD II registry has confirmed the findings of the randomized clinical trials in a real-life environment where ICD implantation rates were lower than suggested by study results and guidelines,” Heinz Vöeller, MD, a professor of medicine from the Klinik am See in Ruedersdorf, Germany, said in a press release. “Noteworthy in this registry was an increasing reduction of mortality over time, depending on the time interval between index infarction and ICD implantation. However, when interpreting the data, it should be remembered that registry analyses do not in general have the confirmative power of a randomized controlled trial with causal connections.”

In the discussant presentation, Panagiotis E. Vardas, MD,a professor of cardiology at Heraklion University Hospital in Crete, Greece, said that the registry results were reasonable and expected, but was concerned at the relatively low rates of ICD implantation.

“We have to speculate very briefly why the registry showed low rates of implantation in a country that has the highest rate of ICD implantations in Europe,” Vardas said in his presentation. “It is possible that patients are coming from areas with low rates of ICD implantation, or possibly because the doctors did not follow the guidelines during this period in this particular registry. I would emphasize that it reflects some realities in Germany, but even in Germany, there are significant regional differences in ICD implantation rates.”

For more information:

Vöeller H. Session 3590-3591. Presented at: European Society of Cardiology Congress; Aug. 29-Sept. 2, 2009; Barcelona.