{
  "abstract": "Introduction Implantable cardioverter defibrillators (ICD’s) play a key role in preventing sudden cardiac death (SCD) in patients with ischaemic cardiomyopathy. Since 2014, primary percutaneous coronary intervention (PPCI) has been the exclusive method of reperfusion for ST-elevation myocardial infarction (STEMI) in Northern Ireland. We sought to evaluate the need for ICD implantation and the occurrence of ICD therapies during long-term follow-up in patients who had undergone PPCI for STEMI.Methods We identified all patients who underwent PPCI at the Belfast Heart Attack Centre in 2014 and collected clinical data from the Northern Ireland Electronic Care Record covering the subsequent 10 years. All patients who received an ICD were identified, and ICD interrogation reports were analysed to document any device discharges or anti-tachycardia therapies. Five patients with ICD’s prior to PPCI were excluded.Results Among 691 patients who underwent PPCI in 2014 (mean age 64.2 ± 13.3 yrs; 25.4% female), 91 exhibited severe left ventricular systolic dysfunction on early post-infarction echocardiography. Of these, 28 showed LVEF improvement by at least one category with guideline-directed medical therapy (GDMT), while 41 patients died within the first three months. Over a median follow-up of 10.5 years, 34 patients (4.9%) received an ICD, 21 (62%) for a primary prevention indication. During a total of 231 patient-years of follow-up, six ICD therapies were administered (five appropriate), at a median of 2.5 years following implantation. The ten-year all-cause mortality rate was 11.8% (four deaths) in the ICD group, compared to 35.3% in the overall PPCI population. Results summarised in table 1.Conclusions Implantable cardioverter defibrillators were rarely required and ICD therapies were infrequent over ten years of follow-up after PPCI for STEMI. While ICD’s retain an important role in the management of ischaemic heart disease, the number of patients requiring ICD may be decreasing in the era of PPCI and guideline-directed medical therapy.Abstract 15 Table 1Clinical characteristics of 34 patients who received an implantable cardioverter defibrillator (ICD) during 10-year follow up after primary PCI for STEMI Primary prevention Secondary prevention n 21 13 Baseline LVEF (Mean +/- SD) 27% (+/- 6%) 34% (+/- 7%) Mean patient-years of follow-up 10 9 ICD therapies: Appropriate ICD discharge 2 1 Anti-tachycardia pacing 1 1 Death during follow up 1 3",
  "authors": [
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "M Todd"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "P Savage"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "B Cox"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "M McKane"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "S McCance"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "J Ruddell"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "C Brines"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "B McGowan"
    },
    {
      "affiliations": [
        "Royal Victoria Hospital, Belfast, UK"
      ],
      "name": "N Herity"
    }
  ],
  "title": "15 Implantable cardioverter defibrillators are rarely needed after ST elevation MI in the era of primary PCI and guideline-directed medical therapy: a 10 year follow up study",
  "uid": "7c02bba9-8843-5441-bbaa-342968ddecab"
}