155 Incidence screening of patients following ST elevation myocardial infarction for primary prevention implantable cardioverter defibrillator (ICD) implantation has a low therapeutic yield

Abstract

<h3>Introduction</h3> The ICD implant rate for the United Kingdom is low compared with the European Union and United States of America. National Institute of Clinical Excellence guidance TAO95 (NICE 2006) makes recommendations for primary prevention ICD implantation. Our study investigated the feasibility of systematically screening patients following an acute ST elevation myocardial infarction (STEMI) to improve local ICD implant rates. <h3>Method</h3> A prospective single centre study was performed over 14-months, in tertiary centre setting. All patients with a diagnosis of an acute STEMI had an echocardiogram at 6 weeks to assess left ventricular ejection fraction (LVEF). Patients with impaired LVEF then underwent screening for primary prevention ICD as per TA095 recommendations (Abstract 155 figure 1). <h3>Results</h3> 326 STEMI patients were identified. Of these 12(3.7%) declined investigation. 25(7.8%) died during the investigation period (22 died during their initial acute event, 3 died of non cardiac causes following discharge). 10(3.1%) requested follow-up in another geographical area. 26(8%) patients were identified as LVEF&lt;35%; 2(0.6%) patients were assessed as not clinically suitable for further investigation. 2(0.6%) had LVEF&lt;30% and QRS&gt;120 ms, both proceeded to have a primary prevention ICD implanted. 24(7.4%) patients had Holter monitors; 2(0.6%) were identified as having episodes of NSVT. Both patients had EPS; 1(0.3%) had inducible VT and proceeded to have a primary prevention ICD implanted. 1 patient (0.3%) self presented with a cardiac arrest before completion of their screening tests and received a secondary prevention ICD. In total, 3(0.9%) primary prevention ICDs were implanted (Abstract 155 figure 2). <h3>Conclusion</h3> The yield from this study was low; 3 patients (0.9%) proceeded to primary prevention ICD. It should also be noted that the methodology resultant from TA095 guidelines was labour and resource intensive. An alternative approach of opportunistic screening in patient groups with a high prevalence of impaired LV function might give a higher yield than our approach looking at disease incidence.