Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Wearable Cardioverter-Defibrillator Use After MI

N Engl J Med; 2018 Sep 27; Olgin, et al

A wearable cardioverter-defibrillator did not lead to significantly lower rate of arrhythmic death among patients with a recent myocardial infarction (MI) and an ejection fraction of ≤35%, a recent study found. Patients with acute MI and an ejection fraction of ≤35% were randomly assigned (2:1) to receive a wearable cardioverter-defibrillator plus guideline-directed therapy (device group) or to receive only guideline-directed therapy (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. Among the details:

  • Of 2,302 study participants, 1,524 were randomly assigned to the device group and 778 to the control group.
  • Device group participants wore the device for a median of 18.0 hours/day.
  • Arrhythmic death occurred in 1.6% of participants in the device group vs 2.4% in the control group (relative risk [RR], 0.67).
  • Death from any cause occurred in 3.1% of those in the device group vs 4.9% in the control group (RR, 0.64) and nonarrhythmic death in 1.4% and 2.2%, respectively, (RR, 0.63).

Citation:

Olgin JE, Pletcher MJ, Vittinghoff E, et al. Wearable cardioverter-defibrillator after myocardial infarction. N Engl J Med. 2018;379:1205-1215. doi:10.1056/NEJMoa1800781.

This Week's Must Reads

Dental device borrowed from sports world no help in pushing, Bergh E et al. Am J Obstet Gynecol. 2019 Jan;220(1):S39, Abstract 49

Enterovirus in at-risk children associated with later celiac disease, Kahrs CR et al. BMJ. 2019 Feb 13. doi: 10.1136/bmj.l231

List of medications linked to drug-induced lupus expands, Arnaud L et al. Ann Rheum Dis. 2019 Feb 4. doi: 10.1136/annrheumdis-2018-214598

Possible mechanism for fluoroquinolone-induced aortopathy uncovered, Guzzardi DG et al. J Thorac Cardiovasc Surg. 2019;157:109-19.

One postdelivery antibiotic dose nearly halves infection in operative delivery, Knight M. et al. Am J Obstet Gynecol 2019 Jan;220;1:S685. Abstract LB 3.

Must Reads in Cardiology

Possible mechanism for fluoroquinolone-induced aortopathy uncovered, Guzzardi DG et al. J Thorac Cardiovasc Surg. 2019;157:109-19.

Intensive BP Control & Risk of Dementia, JAMA; ePub 2019 Jan 28; SPRINT MIND Investigators

Aspirin for Prevention of CV Events, JAMA; 2019 Jan 22; Zheng, Roddick

Educational Attainment & CV Risk in Hispanic Persons, JAMA Cardiol; 2019 Jan; Rodriguez, Leonard, et al

Long-Term Absolute Risk for CVD by FG Level, Diabetes Care; ePub 2019 Jan 7; Bancks, et al