Author + information
- Fatma Demirel,
- Jan Paul Ottervanger,
- Arif Elvan and
- Anand R. Ramdat Misier
It is not known which patients after primary Percutaneous Coronary Intervention (PCI) for ST elevation myocardial infarction (STEMI) have survival benefit of prophylactic implantable cardio defibrillator(ICD). The aim of the DAPA trial is to evaluate the efficacy and safety of ICD in high risk patients after primary PCI for STEMI.
A prospective randomized, multicenter controlled study to compare ICD plus conventional medical therapy vs. conventional medical therapy alone in patients with primary PCI for STEMI. Inclusion criteria were TIMI flow less than 3 after primary PCI or left ventricular ejection fraction lower than 30%. ICD was implanted between 30 and 60 days after the index STEMI. Primary endpoint was all-cause mortality after at least 3 years follow-up. The planned sample size was 700 patients, with 350 patients in each group with intention-to-treat analysis.
After inclusion of 266 patients, enrollment was stopped after advice of the data safety board. Mean age was 60.8 ± 11.3 years, 78.2% was male. Baseline characteristics were comparable between the two treatment groups. Cross-over was 15.6% in the non-ICD group and 2.3% in the ICD group. All-cause mortality was significantly lower in the ICD-group vs. the conventional group (4.8% vs. 11.8% p=0.05). Documented sudden cardiac death was 0.8% in the ICD group versus 3.6% in the non-ICD group (p=0.19).
In patients with a high risk of death after primary PCI for STEMI, ICD lowers long-term mortality. However the results of this trial should be interpreted cautiously, since the study was stopped prematurely.
Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: STEMI
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1190-228
- 2014 American College of Cardiology Foundation