Defibrillator in Acute Myocardial Infarction Trial Presented at American College of Cardiology Scientific Sessions 2004 Presented by Drs. Stewart Connelly and Stefan H. Hohnloser DINAMITDINAMIT

DINAMIT Presented at ACC Scientific Sessions 2004 ICD Therapy Prophylactic implantable cardioverter defibrillator (ICD) n=332 ICD Therapy Prophylactic implantable cardioverter defibrillator (ICD) n=332 Endpoints (2.5 years): All-cause mortality adjudicated by blinded committee Endpoints (2.5 years): All-cause mortality adjudicated by blinded committee No ICD Theraby n=342 No ICD Theraby n= high-risk patients with recent MI, LVEF ≤35%, and evidence of impaired cardiac autonomic modulation Randomized, open-label, multicenter 674 high-risk patients with recent MI, LVEF ≤35%, and evidence of impaired cardiac autonomic modulation Randomized, open-label, multicenter

All-cause Mortality HR 1.08, p=0.66 Presented at ACC Scientific Sessions 2004 Death due to Nonarrhythmia HR 1.75, p=0.016 DINAMITDINAMIT %

The ICD was implanted a median of seven days after the index MI Medical therapy included beta- blockers (87%), angiotensin- converting enzyme inhibitors (95%), antiplatelet agents (92%), and lipid- lowering agents (~80%). The primary endpoint of all-cause mortality did not differ between treatment arms Death due to arrhythmia was lower in the ICD arm while non-arrhythmia deaths were higher in the ICD arm Presented at ACC Scientific Sessions 2004 % DINAMITDINAMIT Death due to Arrhythmia HR 0.42, p=0.009

Among recent post-MI patients, prophylactic implantable defibrillator therapy was not associated with a reduction in the primary endpoint of all- cause mortality compared with optimal medical therapy The frequency of arrhythmia deaths was lower in the prophylactic ICD therapy arm, but non-arrhythmia deaths were higher in the ICD arm. The reason that non-arrhythmic deaths were increased is unclear, but it has been speculated that this may reflect play of chance, a failure to impact recurrent MI/ ischemia or a higher incidence of adverse remodeling. Prophylactic ICD therapy has been associated with improved survival in patients with ischemic cardiomyopathy, but prophylactic use had not previously been evaluated in recent post-MI patients. Among recent post-MI patients, prophylactic implantable defibrillator therapy was not associated with a reduction in the primary endpoint of all- cause mortality compared with optimal medical therapy The frequency of arrhythmia deaths was lower in the prophylactic ICD therapy arm, but non-arrhythmia deaths were higher in the ICD arm. The reason that non-arrhythmic deaths were increased is unclear, but it has been speculated that this may reflect play of chance, a failure to impact recurrent MI/ ischemia or a higher incidence of adverse remodeling. Prophylactic ICD therapy has been associated with improved survival in patients with ischemic cardiomyopathy, but prophylactic use had not previously been evaluated in recent post-MI patients. DINAMITDINAMIT