1. Defibrillator in Acute Myocardial Infarction Trial
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. Death due to Nonarrhythmia
DINAMIT
All-cause Mortality
HR 1.08, p=0.66
Death due to Nonarrhythmia
HR 1.75, p=0.016 %
Presented at ACC Scientific Sessions 2004

4. Death due to Arrhythmia
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.