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(Circulation. 2004;109:1082-1084.)
© 2004 American Heart Association, Inc.

Brief Rapid Communications

Time Dependence of Mortality Risk and Defibrillator Benefit After Myocardial Infarction

David J. Wilber, MD; Wojciech Zareba, MD; W. Jackson Hall, PhD; Mary W. Brown, MS; Albert C. Lin, MD; Mark L. Andrews, BBS; Martin Burke, DO; Arthur J. Moss, MD

From the Cardiovascular Institute, Loyola University Medical Center, Maywood, Ill (D.J.W., A.C.L., M.B.), and the Cardiology Unit (W.Z., M.W.B., M.L.A., A.J.M.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY.

Correspondence to David J. Wilber, MD, Loyola Cardiovascular Institute, Bldg 110, Room 6232, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153. E-mail dwilber{at}lumc.edu

Received October 25, 2003; revision received January 6, 2004; accepted January 16, 2004.

Background— Prophylactic implantable defibrillators (ICDs) improve survival in patients with impaired ventricular function after myocardial infarction (MI), but it is uncertain whether mortality risk and survival benefit depend on the elapsed time from MI.

Methods and Results— The Multicenter Automatic Defibrillator Implantation Trial II examined the impact of ICDs on survival in post-MI patients with ejection fractions 30%. In 1159 patients, mean time from most recent MI to enrollment was 81±78 months. Patients were randomized to an ICD (n=699) or conventional care (n=460) in a 3:2 ratio. Mortality rates (deaths per 100 person-years of follow-up) in both treatment groups were analyzed by time from MI divided into quartiles (<18, 18 to 59, 60 to 119, and 120 months). In conventional care patients, these rates increased as time from MI increased (7.8%, 8.4%, 11.6%, 14.0%; P=0.03). Mortality rates in ICD patients were consistently lower in each quartile and showed minimal increase over time (7.2%, 4.9%, 8.2%, 9.0%; P=0.19). Covariate-adjusted hazard ratios for risk of death associated with ICD therapy were 0.97 (95% CI, 0.51 to 1.81; P=0.92) for recent MI (<18 months) and 0.55 (95% CI, 0.39 to 0.78; P=0.001) for remote MI (18 months).

Conclusions— Mortality risk in patients with ejection fractions 30% increases as a function of time from MI. The survival benefit associated with ICDs appears to be greater for remote MI and remains substantial for up to 15 years after MI.

Key Words: defibrillation • myocardial infarction • survival

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