Prevalence and Clinical Course of Patients in Spain With Acute Myocardial Infarction and Severely Depressed Ejection Fraction Who Meet the Criteria for Automatic Defibrillator Implantation

The Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II has broadened the indications for cardioverter defibrillator implantation. We present a retrospective study designed to estimate the number of patients in Spain eligible for an implantable defibrillator according to the MADIT-II criteria. From January 1999 to October 2002, 758 consecutive patients were admitted to our center with the diagnosis of acute myocardial infarction. Sixty-seven had a left ventricular ejection fractionor = 30% (mean, 23[5]) and were not eligible for revascularization. Excluding patients older than 80 years and patients with marked co-morbidity, 47 patients met the MADIT-II criteria for an implantable defibrillator. After a mean follow-up of 18 months, there were 20 deaths, 6 of which were considered sudden. In conclusion, application of the MADIT-II criteria for defibrillator implantation may benefit 6% of the patients with myocardial infarction in Spain. This proportion translates as 4110 defibrillator implantations.