Department of Cardiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands.
Europace. 2010 Mar;12(3):378-84. doi: 10.1093/europace/eup420. Epub 2010 Jan 6.
To assess the number of patients in daily clinical practice that meets criteria for implantation of an implantable cardioverter defibrillator (ICD) following acute myocardial infarction (AMI) when treated according to an aggressive treatment protocol.
Patients were treated according to the MISSION! protocol. The protocol encompasses pre-hospital, in-hospital, and outpatient clinical framework for the acute and chronic treatment of AMI patients and the decision making regarding primary prevention of sudden cardiac death (SCD). A total of 676 consecutive AMI patients (78% male, mean age 59 +/- 12 years) treated according to the MISSION! protocol were included in this analysis. Left ventricular ejection fraction at 3 months was 54 +/- 10%. Only 39 (6%) patients met criteria for implantation of an ICD <1 year post-MI. These patients suffered more extensive infarctions as indicated by higher peak troponin T values (mean 14.5 +/- 8.3 vs. 6.5 +/- 14.7 microg/L; P < 0.001) and had more left anterior descending artery related infarctions (79 vs. 46%; P < 0.001). Cumulative first appropriate therapy rate was 15% at 3 years follow-up. No SCD was observed in the study population.
Aggressive treatment of AMI patients and close monitoring after the index event according to a standardized protocol, results in only a small number of patients becoming candidate for prophylactic ICD implantation. An easy-to-use protocol combining aggressive reperfusion, optimal medication, and a risk stratification algorithm tailored to fit within routine practice may help to maintain ICD implantation rates within manageable proportions.
评估根据强化治疗方案治疗急性心肌梗死（AMI）后符合植入埋藏式心脏复律除颤器（ICD）标准的患者数量。
患者根据 MISSION! 方案进行治疗。该方案涵盖了 AMI 患者的院前、院内和门诊临床框架，用于急性和慢性治疗 AMI 患者，并对预防心源性猝死（SCD）做出决策。本分析共纳入 676 例连续 AMI 患者（78%为男性，平均年龄 59 ± 12 岁），根据 MISSION! 方案进行治疗。3 个月时左心室射血分数为 54 ± 10%。仅 39 例（6%）患者在 MI 后 1 年内符合植入 ICD 的标准。这些患者的心肌梗死范围更广，表现为肌钙蛋白 T 峰值更高（平均值 14.5 ± 8.3 比 6.5 ± 14.7μg/L；P<0.001），前降支相关梗死更多（79%比 46%；P<0.001）。3 年随访时，首次适当治疗的累积发生率为 15%。研究人群中未观察到 SCD。
根据标准化方案积极治疗 AMI 患者，并在指数事件后密切监测，只有少数患者成为预防性 ICD 植入的候选者。一个易于使用的方案，结合积极的再灌注、最佳药物治疗和针对常规实践量身定制的风险分层算法，可能有助于将 ICD 植入率控制在可管理的范围内。
