{"id":8549,"date":"2025-09-05T19:58:07","date_gmt":"2025-09-05T16:58:07","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8549"},"modified":"2025-09-05T19:58:07","modified_gmt":"2025-09-05T16:58:07","slug":"refine-icd-trial-primary-prevention-icd-after-mi-2","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/refine-icd-trial-primary-prevention-icd-after-mi-2\/","title":{"rendered":"REFINE-ICD Trial -Primary Prevention ICD After MI"},"content":{"rendered":"<div>REFINE-ICD Trial -Primary Prevention ICD After MI<\/div>\n<div><\/div>\n<div>Source: ESC 2025 Medical News | August 31, 2025<\/div>\n<div><\/div>\n<div><span> 1. Background<\/span><\/div>\n<div><span> \u2022 ICDs are used for primary prevention of sudden cardiac death in post-MI patients with reduced LVEF.<\/span><\/div>\n<div><span> \u2022 The REFINE-ICD trial tested whether autonomic\/electrical risk markers could identify patients who might benefit.<\/span><\/div>\n<div><span> 2. Study Design<\/span><\/div>\n<div><span> \u2022 ~2000 screened; 597 enrolled (mean age 65; 20% female).<\/span><\/div>\n<div><span> \u2022 Patients post-MI, LVEF 35\u201350%, with abnormal heart rate (HR) turbulence and exercise T-wave alternans (TWA):<\/span><\/div>\n<div><span> \u2022 Abnormal HR turbulence = loss of the normal acceleration\u2013deceleration pattern of heart rate after a premature beat, reflecting autonomic dysfunction.<\/span><\/div>\n<div><span> \u2022 Abnormal TWA = beat-to-beat alternation in T-wave amplitude or shape on ECG, indicating electrical instability of the myocardium.<\/span><\/div>\n<div><span> \u2022 Sites: US, Canada, Europe, Middle East, Africa.<\/span><\/div>\n<div><span> \u2022 Follow-up: mean ~6 years.<\/span><\/div>\n<div><span> 3. Results<\/span><\/div>\n<div><span> \u2022 Enrolled patients (with abnormal markers) had 2.6\u00d7 higher risk of death vs those without abnormalities.<\/span><\/div>\n<div><span> \u2022 Mortality at ~6 years: ICD 24.5% vs no-ICD 21.3% (HR 1.07; CI 0.77\u20131.50; p=0.69).<\/span><\/div>\n<div><span> \u2022 Sudden death rates were very low: 2.6% (ICD) vs 3.8% (control).<\/span><\/div>\n<div><span> \u2022 Non-cardiac deaths outnumbered cardiac deaths.<\/span><\/div>\n<div><span> 4. Key Observations<\/span><\/div>\n<div><span> \u2022 Even in high-risk patients, modern therapy kept sudden death risk low.<\/span><\/div>\n<div><span> \u2022 ICD offered no survival benefit in this group.<\/span><\/div>\n<div><span> \u2022 Event rates were low enough to suggest results are reliable despite wide CIs.<\/span><\/div>\n<div><span> 5. Implications<\/span><\/div>\n<div><span> \u2022 No role for primary prevention ICD in post-MI patients with LVEF 35\u201350% and abnormal HR turbulence\/TWA.<\/span><\/div>\n<div><span> \u2022 Modern revascularization and drugs (ARNI, SGLT2i, etc.) have transformed outcomes.<\/span><\/div>\n<div><span> \u2022 Findings align with DANISH trial and declining sudden death rates globally.<\/span><\/div>\n<div><span> \u2022 Supports PROFID-EHRA trial to retest ICD value in ischemic cardiomyopathy.<\/span><\/div>\n<div><\/div>\n<div><a href=\"https:\/\/click.mail.medscape.com\/?qs=a40218696a315d46b5640ac484768579fd3573ea4835d2a33b88a8f7b4f60bfbfd8b5e8f917b237017b5d320272dbdc3424db8b86414116f6202f5bade4e09a4\">https:\/\/click.mail.medscape.com\/?qs=a40218696a315d46b5640ac484768579fd3573ea4835d2a33b88a8f7b4f60bfbfd8b5e8f917b237017b5d320272dbdc3424db8b86414116f6202f5bade4e09a4<\/a><\/div>\n<div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>REFINE-ICD Trial -Primary Prevention ICD After MI Source: ESC 2025 Medical News | August 31, 2025 1. Background \u2022 ICDs are used for primary prevention of sudden cardiac death in post-MI patients with reduced LVEF. \u2022 The REFINE-ICD trial tested whether autonomic\/electrical risk markers could identify patients who might benefit. 2. Study Design \u2022 ~2000 [&hellip;]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8549","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8549","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8549"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8549\/revisions"}],"predecessor-version":[{"id":8550,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8549\/revisions\/8550"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8549"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8549"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8549"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}