Defibrillator in Acute Myocardial Infarction Trial

1. DINAMIT Defibrillator in Acute Myocardial Infarction Trial Presented at American College of Cardiology Scientific Sessions 2004 Presented by Drs. Stewart Connelly and Stefan H. Hohnloser

2. DINAMIT 674 high-risk patients with recent MI, LVEF ≤35%, and evidence of impaired cardiac autonomic modulation Randomized, open-label, multicenter ICD Therapy Prophylactic implantable cardioverter defibrillator (ICD) n=332 No ICD Theraby n=342 • Endpoints (2.5 years): All-cause mortality adjudicated by blinded committee Presented at ACC Scientific Sessions 2004

3. DINAMIT Death due to Nonarrhythmia HR 1.75, p=0.016 All-cause Mortality HR 1.08, p=0.66 % Presented at ACC Scientific Sessions 2004

4. DINAMIT Death due to Arrhythmia HR 0.42, p=0.009 • The ICD was implanted a median of seven days after the index MI • Medical therapy included beta-blockers (87%), angiotensin-converting enzyme inhibitors (95%), antiplatelet agents (92%), and lipid-lowering agents (~80%). • The primary endpoint of all-cause mortality did not differ between treatment arms • Death due to arrhythmia was lower in the ICD arm while non-arrhythmia deaths were higher in the ICD arm % Presented at ACC Scientific Sessions 2004

5. DINAMIT • Among recent post-MI patients, prophylactic implantable defibrillator therapy was not associated with a reduction in the primary endpoint of all-cause mortality compared with optimal medical therapy • The frequency of arrhythmia deaths was lower in the prophylactic ICD therapy arm, but non-arrhythmia deaths were higher in the ICD arm. • The reason that non-arrhythmic deaths were increased is unclear, but it has been speculated that this may reflect play of chance, a failure to impact recurrent MI/ ischemia or a higher incidence of adverse remodeling. • Prophylactic ICD therapy has been associated with improved survival in patients with ischemic cardiomyopathy, but prophylactic use had not previously been evaluated in recent post-MI patients.