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Wearable Cardioverter–Defibrillator after Myocardial Infarction

Open access
Olgin, Jeffrey E., Pletcher, Mark J., Vittinghoff, Eric, Wranicz, Jerzy, Malik, Rajesh, Morin, Daniel P., Zweibel, Steven, Buxton, Alfred E., Elayi, Claude S., Chung, Eugene H., Rashba, Eric, Borggrefe, Martin, Hue, Trisha F., Maguire, Carol, Lin, Feng, Simon, Joel A., Hulley, Stephen, Lee, Byron K.·2018·New England Journal of Medicine

Abstract

BACKGROUND: Despite the high rate of sudden death after myocardial infarction among patients with a low ejection fraction, implantable cardioverter-defibrillators are contraindicated until 40 to 90 days after myocardial infarction. Whether a wearable cardioverter-defibrillator would reduce the incidence of sudden death during this high-risk period is unclear. METHODS: We randomly assigned (in a 2:1 ratio) patients with acute myocardial infarction and an ejection fraction of 35% or less to receive a wearable cardioverter-defibrillator plus guideline-directed therapy (the device group) or to receive only guideline-directed therapy (the control group). The primary outcome was the composite of sudden death or death from ventricular tachyarrhythmia at 90 days (arrhythmic death). Secondary outcomes included death from any cause and nonarrhythmic death. RESULTS: Of 2302 participants, 1524 were randomly assigned to the device group and 778 to the control group. Participants in the device group wore the device for a median of 18.0 hours per day (interquartile range, 3.8 to 22.7). Arrhythmic death occurred in 1.6% of the participants in the device group and in 2.4% of those in the control group (relative risk, 0.67; 95% confidence interval [CI], 0.37 to 1.21; P=0.18). Death from any cause occurred in 3.1% of the participants in the device group and in 4.9% of those in the control group (relative risk, 0.64; 95% CI, 0.43 to 0.98; uncorrected P=0.04), and nonarrhythmic death in 1.4% and 2.2%, respectively (relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P=0.15). Of the 48 participants in the device group who died, 12 were wearing the device at the time of death. A total of 20 participants in the device group (1.3%) received an appropriate shock, and 9 (0.6%) received an inappropriate shock. CONCLUSIONS: Among patients with a recent myocardial infarction and an ejection fraction of 35% or less, the wearable cardioverter-defibrillator did not lead to a significantly lower rate of the primary outcome of arrhythmic death than control. (Funded by the National Institutes of Health and Zoll Medical; VEST ClinicalTrials.gov number, NCT01446965 .).

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Metadata

Authors
Olgin, J. E., Pletcher, M. J., Vittinghoff, E., Wranicz, J., Malik, R., Morin, D. P., Zweibel, S., Buxton, A. E., Elayi, C. S., Chung, E. H., Rashba, E., Borggrefe, M., Hue, T. F., Maguire, C., Lin, F., Simon, J. A., Hulley, S., & Lee, B. K.
Venue
New England Journal of Medicine
Published
2018-09-27
Volume
379
Issue
13
Pages
1205-1215
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2893496325
Cited by
285
References
42
FWCI
24.60
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Wearable Cardioverter–Defibrillator after Myocardial Infarction. https://app.cochat.ai/papers/10.1056/nejmoa1800781
The paper
Olgin, J. E., Pletcher, M. J., Vittinghoff, E., Wranicz, J., Malik, R., Morin, D. P., Zweibel, S., Buxton, A. E., Elayi, C. S., Chung, E. H., Rashba, E., Borggrefe, M., Hue, T. F., Maguire, C., Lin, F., Simon, J. A., Hulley, S., & Lee, B. K. (2018). Wearable Cardioverter–Defibrillator after Myocardial Infarction. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1800781

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.