Risk Stratification of Post-MI Patients. What Are the Limitations of MADIT? What Does the Future Hold in Store?

Abstract

That the implantable cardioverter-defibrillator (ICD) prevents sudden death, and does so more effectively than any other therapy, is clear and inarguable. Aside from countless eyewitness accounts of cardiac arrest being aborted by ICDs, published reports have, from the very beginning, clearly documented the remarkable effectiveness of this device in terminating lethal ventricular arrhythmias [1–4]. In patients who received the ICD the incidence of sudden death was reduced to < 2% at 1 year and ≤ 6% at 5 years. Thus, by the late 1980s, accumulated data from around the world provided ample proof that the ICD was highly effective at doing exactly what it was designed to do and that no other therapy provided the same level of protection against sudden death. The fact that the ICD prevents sudden death leads immediately to a truth that is so self-evident and indisputable as to constitute an axiom [4]. The axiom states that the ability of the ICD to measurably prolong survival depends on the population of patients to which it is applied. Indeed, in a given population followed for a given period of time, the ICD will measurably prolong overall survival whenever the risk of sudden death from ventricular tachyarrhythmias is sufficiently greater than the risk of dying from all other causes combined.