Authors: Alfred P Hallstrom D George Wyse John McAnulty for the CAST and AVID Investigators
Publish Date: 2008/09/23
Volume: 23, Issue: 3, Pages: 159-166
Abstract
Three clinical factors from the Antiarrhythmics Versus Implantable Defibrillators AVID trial—heart failure left ventricular dysfunction and certain historical features defined a subgroup in which an implantable cardioverter defibrillator ICD/PM has a mortality advantage over amiodaroneSimilar predictive power was noted in AVID patients with IHD In CAST the factors defined three groups one group 58 corresponding to AVID patients that had high risk and benefited from an ICD/PM and another group 172 corresponding to patients in AVID where the risk was moderate and ICD/PM and amiodarone had equal efficacy demonstrated a twofold higher risk of sudden arrhythmic than nonarrhythmic death and hence would be expected to benefit from antiarrhythmia therapy The third group corresponding to AVID patients with low risk of arrhythmia demonstrated similar and low risks of sudden arrhythmic and nonarrhythmic death Thus this group 77 is unlikely to benefit from indiscriminate antiarrhythmia therapy Onset of risk of death in CAST patients was offset from randomization by 3 to 6 monthsReadily available clinical criteria identify a small group likely to benefit from an ICD/PM after recent myocardial infarction MI and the remainder unlikely to benefit from nonselective ICD/PM therapy Additional risk stratification should focus on the latter patients and be timed to allow ICD/PM implantation between 2 and 6 months after MI
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