Wearable Defibrillator Trial Has Mixed Result.

Abstract

The much-awaited results of the VEST trial (Vest Prevention of Early Sudden Death Trial) failed to provide the definitive answer on the potential value of wearable cardioverter-defibrillators (WCDs) in reducing sudden death during the vulnerable period just after a myocardial infarction. The VEST trial was the first multicenter, randomized controlled trial of WCDs in patients with an ejection fraction ≤35% after an acute myocardial infarction. In the trial, 2302 patients were randomly assigned in a 2:1 ratio to medical therapy plus a WCD or medical therapy alone at 108 sites in 4 countries. It failed to meet its primary end point of a reduction in sudden death during the first 90 days after a heart attack, but it did show a significant reduction in all-cause mortality, its secondary end point, according to data presented at the American College of Cardiology 2018 Scientific Session. “This is a very important study,” said Dhanunjaya Lakkireddy, MD, director of the Center for Excellence in AF and Complex Arrhythmias at the University of Kansas Medical Center. He noted that low compliance among a subgroup of patients may have contributed to the results and that subgroup analyses may help to determine whether this was true or if certain subgroups of patients benefited. Valentina Kutyifa, MD, PhD, associate professor in the Department of Medicine at the University of Rochester in New York, agreed that …