4-029 Implantable cardioverter defibrillators are required rarely during long-term follow up after ST elevation MI in the era of primary PCI and guideline directed medical therapy

Introduction Implantable cardioverter defibrillators (ICD’s) play a central role in the prevention of sudden cardiac death (SCD), including patients with ischaemic cardiomyopathy whose left ventricular ejection fraction (LVEF) remains ≤35% despite optimal guideline directed medical therapy (GDMT). We sought to evaluate the need for ICD implantation and for subsequent ICD therapies during long-term follow-up of patients who had undergone primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI).Methods We identified all patients treated with PPCI in the Belfast Heart Attack Centre during 2014 and obtained clinical data from the Northern Ireland Electronic Care Record covering the subsequent 10 years. We evaluated all patients who received an ICD, reviewed all ICD interrogation reports, and recorded any ICD discharges or anti-tachycardia therapies. Five patients who already had an ICD prior to their index PPCI event were excluded.Results Of 691 patients treated with PPCI in 2014 (mean age 64.2 ± 13.3 years; 25.4% female), 91 had evidence of severe left ventricular systolic dysfunction on the early post-infarct echocardiogram. Twenty-eight of these demonstrated recovery of LVEF by at least one category following GDMT and 41 patients died within the first three months.During a median follow-up of 10.5 years, 34 patients (4.9%) received an ICD, 21 (62%) of which were for primary prevention. Across 231 patient-years of follow-up, six ICD therapies were delivered (five appropriate), occurring at a median of 2.5 years post-implantation.Ten-year all-cause mortality was 11.8% (four deaths) in the ICD group, compared with 35.3% in the overall PPCI population.Conclusions Implantable cardioverter defibrillators were required infrequently and activated rarely over ten years of follow-up after PPCI for STEMI. While ICD’s retain an important role in the management of ischaemic heart disease, the number of patients requiring them may be decreasing in the era of PPCI and modern guideline-directed medical therapy.Abstract 4-029 Table 1Clinical characteristics of 34 patients who received an implantable cardioverter defibrillator (ICD) during 10-year follow up after primary PCI for STEMI Primary prevention Secondary prevention n 21 13 Baseline LVEF 27% (+/- 6%) 34% (+/- 7%) Patient-years of follow-up 9.97 9.16 Therapies: Appropriate ICD discharge 2 1 Anti-tachycardia pacing 1 1 Death during follow up 1 3