Why Don't Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death After Recent Myocardial Infarction?

The risk for sudden cardiac death (SCD) is particularly high in the early months after a myocardial infarction (MI). However, two trials of prophylactic implantable cardioverter-defibrillator (ICD) placement after MI failed to show a survival benefit in ICD recipients (JW Cardiol Jan 28 2005 and Oct 7 2009), in contrast to results of other ICD trials. To examine this lack of benefit more closely, investigators studied data from VALIANT, an international trial of valsartan in MI survivors.

Of 14,703 participants with left ventricular dysfunction, clinical heart failure, or both, 2878 died during a median of 25 months of follow-up, and autopsy results were available for 398. Of these, the cause of death was clinically judged to be SCD in 105; …