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Original research article
The 7-year teesside experience of primary prevention ICD indications following primary PCI (PPCI) and the potential impact of a change in NICE guidance
  1. Thanh Trung Phan1,
  2. Saima Khan1,
  3. Muhammad Muzaffar Mahmood1,
  4. Sudha Mani2,
  5. Vineet Wadehra3,
  6. Mark de Belder1,
  7. Andrew Thornley1,
  8. Simon James1,
  9. Nicholas J Linker1 and
  10. Andrew J Turley1
  1. 1James Cook University Hospital, Middlesbrough, UK
  2. 2Darlington Memorial Hospital, County Durham, UK
  3. 3University Hospital of North Tees, Stockton-on-Tees, UK
  1. Correspondence to Dr Thanh Phan, The James Cook University Hospital, Marton Road, Middlesbrough. TS4 3BW, UK; ttpquang{at}hotmail.com

Abstract

Introduction The recovery of LV function in patients with severe LV impairment in the acute phase following primary percutaneous coronary intervention (PPCI) is not well established. The indication for a primary prevention ICD post-STEMI is dependent on which screening guidance, NICE or ESC, is followed. The potential impact of the new NICE guidance is estimated.

Methods We performed a retrospective analysis of all patients presenting with a STEMI over a 7-year period (2005–2012) treated with PPCI to determine in-hospital mortality, LV function at index presentation, at 3 months and the predicted primary prevention ICD implantation rate using NICE (TA095) and ESC 2006 guidelines. Predicted implant rates using the new NICE guidance (TA314) and actual implantation rates were also assessed.

Results 3902 patients with a mean age of 65±13 years underwent PPCI. Of those patients surviving until discharge, 332 (10%) had LVEF ≤35%. 254 of 332 patients (76%) with a severely impaired ventricle were followed up at participating centres. 210 of 254 (83%) patients had a repeat echocardiogram within 3 months post-MI; among these patients, 89 (42%) remained to have LVEF ≤35%. The number of patients fulfilling NICE and ESC criteria for primary prevention ICD implantation was 14 (16%) and 84 (94%), respectively. The actual number of patients receiving an ICD was 17 (19%). The number of patients fulfilling the new NICE (TA314) guidance was 84 (94%).

Conclusions A small proportion of patients with STEMIs undergoing PPCI have a severely impaired LV systolic function. A large proportion of these patients will have improved LV systolic function at 3 months. There is a five-fold difference in the predicted ICD implantation rates depending on which guidance is followed—NICE versus ESC. The potential impact of the new NICE (TA314) guidance on ICD implantation will be a significant increase in ICD implantation rates.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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