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ST-DETECT: High-risk patients with ICDs show low spontaneous coronary event rate

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Society for Cardiovascular Angiography and Interventions 2011 Scientific Sessions

BALTIMORE — The addition of high-fidelity intracardiac electrogram signals in implantable cardioverter defibrillators provided data indicating that high-risk CVD patients experienced low rates of spontaneous coronary events.

“The events are shockingly low,” said study investigator Timothy D. Henry, MD, of the Minneapolis Heart Institute at Abbott Northwestern Hospital. “The results suggest that the [patients’] disease was well managed by a combination of medical therapy and revascularization.” Henry made his remarks while presenting the results of the ST Segment Detection Study (ST-DETECT) at the 2011 Society for Cardiovascular Angiography and Interventions Scientific Sessions.

After implantation of an ICD programmed with high-fidelity intracardiac electrogram (EGM) signals, 175 patients from 32 participating centers were monitored for 24 months. Investigators in this prospective, non-randomized study evaluated whether spontaneous coronary events and exercise-induced cardiac ischemia precipitated detectable changes on the intracardiac EGM signals.

Patients qualified if they had experienced an MI in the previous 6 months, had previously undergone stenting or a percutaneous coronary intervention procedure, had multivessel disease (>1 coronary arteries, >60% stenosis) or had a recent positive stress test with suspected CAD. Antiplatelets were in use by 93% of the study group; 88% were using anti-hyperlipidemia medication; 93% were using beta-blockers; 84% were using ACE inhibitors/angiotensin receptor antagonists; 60% were using diuretics; and 35% were using vasodilators/nitrates.

A blinded, external endpoint committee determined that of the 361 recorded adverse events, based on 174.7 patient-years from 121 patients, 181 were CV-related. The trial, which was based on a 4% annual acute MI rate, was discontinued early.

“This trial illustrates that to implement the potential of this new technology, we need to further study the complex relationship between clinical events, surface ECG and EGM changes,” Henry said. – by Whitney McKnight

Disclosure: Dr. Henry reports having consulted for/receiving honoraria from Medtronic. The trial was sponsored by Medtronic.

For more information:

• Henry T. LBCT I. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 4-7, 2011; Baltimore.

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