Defibrillator After Primary Angioplasty - DAPA

Contribution To Literature:

The DAPA trial showed that early ICD after primary PCI may be beneficial at improving long-term survival.

Description:

The goal of the trial was to evaluate a prophylactic implantable cardioverter-defibrillator (ICD) compared with standard of care among patients who underwent primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Study Design

  • Randomized
  • Parallel

STEMI patients, 30-60 days after their event, were randomized to ICD (n = 129) versus standard of care (n = 133). The ICD was programmed to only give shocks for heart rate >190 bpm.

  • Total number of enrollees: 262
  • Duration of follow-up: 3 years

Inclusion criteria:

Primary PCI for STEMI and ≥1 high risk factor:

  • Left ventricular ejection fraction <30% within 4 days
  • TIMI flow <3 after primary PCI
  • Primary ventricular fibrillation
  • Killip class ≥2

Principal Findings:

The trial was terminated early due to slow enrollment.

The primary net outcome, all-cause mortality at 3 years, occurred in 24.4% of the ICD group compared with 35.5% of the standard care group (p = 0.02).

Interpretation:

Among STEMI patients who underwent primary PCI, early ICD implantation (within 30-60 days) in high-risk patients was beneficial. Early ICD implantation was associated with a reduction in all-cause mortality at 3 years compared with standard of care. High-risk characteristics that guided ICD implantation included early severe left ventricular systolic dysfunction (<30%) and impaired TIMI flow after primary PCI. Confirmatory studies are warranted.

References:

Presented by Dr. Danielle Marianne Haanschoten at the European Society of Cardiology Congress, Paris, France, September 3, 2019.

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Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and ACS

Keywords: ESC Congress, ESC 19, Acute Coronary Syndrome, Angioplasty, Anterior Wall Myocardial Infarction, Arrhythmias, Cardiac, Cardiology Interventions, Defibrillators, Implantable, Heart Failure, Myocardial Infarction, Percutaneous Coronary Intervention, Risk Factors, Secondary Prevention, Standard of Care, Stroke Volume, Ventricular Dysfunction, Left, Ventricular Fibrillation


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