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Multicenter Study
. 2009 Apr;11(4):476-82.
doi: 10.1093/europace/eun349. Epub 2009 Jan 9.

Clinical and arrhythmic outcomes after implantation of a defibrillator for primary prevention of sudden death in patients with post-myocardial infarction cardiomyopathy: The Survey to Evaluate Arrhythmia Rate in High-risk MI patients (SEARCH-MI)

Massimo Santini  1 , Maurizio Russo, Gianluca Botto, Maurizio Lunati, Alessandro Proclemer, Boris Schmidt, Ali Erdogan, Erhard Helmling, Werner Rauhe, Martin Desaga, Elisabetta Santi, Marc Messier, Giuseppe Boriani
Affiliations
Multicenter Study

Clinical and arrhythmic outcomes after implantation of a defibrillator for primary prevention of sudden death in patients with post-myocardial infarction cardiomyopathy: The Survey to Evaluate Arrhythmia Rate in High-risk MI patients (SEARCH-MI)

Massimo Santini et al. Europace. 2009 Apr.

Abstract

Aims: To evaluate clinical and arrhythmic outcomes in post-infarction cardiomyopathy patients implanted with a defibrillator (ICD) for primary prevention of sudden death.

Methods and results: The SEARCH-MI registry is a European multi-centre, prospective, observational study enrolling patients after myocardial infarction, chronic left ventricular dysfunction and an ICD implanted for primary prevention of sudden death. Data on 556 patients with at least one recorded follow-up are presented. Survey to Evaluate Arrhythmia Rate in High-risk MI (SEARCH-MI) patients were sicker than those enrolled in MADIT-II with higher New York Heart Association class and left bundle branch block. Total mortality was 10.4%. Close to one-third (30%) of patients experienced episodes of sustained ventricular arrhythmia. One-quarter (23%) received at least one appropriate therapy and 10% inappropriate therapy. Gender (25% males vs. 5% females, P = 0.0009) and history of non-sustained ventricular tachycardia (24% with vs. 18% without P = 0.037) were predictive of appropriate ventricular therapy.

Conclusion: SEARCH-MI represents the current clinical management of post-MI patients with left ventricular dysfunction indicated to defibrillator implant for primary prevention. European routine clinical practice was influenced by landmark trials and guidelines which impacted on the implantation of cardiac resynchronization therapy in over 25% of such patients. Non-sustained ventricular tachycardia identifies subjects with a higher incidence of appropriate ICD therapy.

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Figures

Figure 1
Figure 1
SEARCH-MI registry Kaplan–Meier estimates of the probability of survival from sudden cardiac death and all cause mortality.
Figure 2
Figure 2
SEARCH-MI registry Kaplan–Meier estimates of first appropriate ventricular therapy and shock.
Figure 3
Figure 3
SEARCH-MI registry Kaplan–Meier probability of appropriate ICD therapy for VT/VF stratified by gender.
See this image and copyright information in PMC

Comment in

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