on March 1, 2004
Circulation. 2004
Published online before print March 1, 2004, doi: 10.1161/01.CIR.0000121328.12536.07
Published online before print March 1, 2004, doi: 10.1161/01.CIR.0000121328.12536.07
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Submitted on October 25, 2003
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. * To whom correspondence should be addressed. E-mail: dwilber{at}lumc.edu.
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 Conclusions--Mortality risk in patients with ejection fractions
Revised on January 6, 2004
Accepted on January 16, 2004
Time Dependence of Mortality Risk and Defibrillator Benefit After Myocardial Infarction
David J. Wilber MD*,
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).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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Circulation 2004 109: 1073-1075.
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