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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
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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=342 674 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
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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 %
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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
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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
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