Skip to main content
Log in

The Defibrillator in Acute Myocardial Infarction Trial (DINAMIT): Rationale, Design and Specific Aims

  • Published:
Cardiac Electrophysiology Review

Abstract

The implantable defibrillator (ICD) effectively palliates arrhythmogenic events and thereby reduces total mortality in patients after a first episode of cardiac arrest. At present, four randomized controlled trials have addressed the issue of primary prevention by the ICD in patients with coronary artery disease and two small studies are available dealing with patients suffering from nonischemic cardiomyopathy. Importantly, none of the randomized studies in patients suffering from coronary artery disease has examined the potential role of the ICD in patients early after myocardial infarction. Within the next 12 months, important additional data is expected from several studies which have completed patient enrolment and follow-up. All studies are prospective randomized trials investigating the effects of ICD compared to optimal medical therapy. This paper summarizes the rationale, design and specific contributions of the Defibrillator in Myocardial infarction trial (DINAMIT) in comparison to other relevant studies on primary prevention of sudden cardiac death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Zipes DP, Wellens HJ. Sudden cardiac death. Circulation 1998;98:2334–2351.

    Google Scholar 

  2. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: Epidemiology, transient risk, and intervention assessment. Ann Intern Med 1993;119:1187–1197.

    Google Scholar 

  3. Myerburg RJ, Interian A, Jr., Mitrani RM, Kessler KM, Castellanos A. Frequency of sudden cardiac death and pro-files of risk. Am J Cardiol 1997;80:10F–19F.

    Google Scholar 

  4. Page RL, Joglar JA, Kowal RC, Zagrodzky JD, Nelson LL, Ramaswamy K, Barbera SJ, Hamdan MH, McKenas DK. Use of automated external defibrillators by a U.S. airline. N Engl J Med 2000;343:1210–1216.

    Google Scholar 

  5. Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000;343:1206–1209.

    Google Scholar 

  6. Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP. Estimating effectiveness of cardiac arrest interventions: A logistic regression survival model. Circulation 1997;96:3308–3313.

    Google Scholar 

  7. Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL, Gibbons RI, Antman EM, Alpert JS, Hiratzka LF, Faxon DP, Jacobs AK, Fuster V, Smith SC, Jr. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: Summary article. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Cardiovasc Electrophysiol 2002;13:1183–1199.

    Google Scholar 

  8. Myerburg RJ, Mitrani R, Interian A, Jr., Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials: Design features and population impact. Circulation 1998;97:1514–1521.

    Google Scholar 

  9. Gottlieb SS, McCarter RJ, Vogel RA. Effect of betablockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998;339:489–497.

    Google Scholar 

  10. Cairns JA, Connolly SJ, Roberts R, Gent M. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet 1997;349:675–682.

    Google Scholar 

  11. Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, Arensberg D, Baker A, Friedman L, Greene HL. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991;324:781–788.

    Google Scholar 

  12. Julian DG, Camm AJ, Frangin G, Janse MJ, Munoz A, Schwartz PJ, Simon P. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. European Myocardial Infarct Amiodarone Trial Investigators. Lancet 1997;349:667–674.

    Google Scholar 

  13. Waldo AL, Camm AJ, deRuyter H, Friedman PL, MacNeil DJ, Pauls JF, Pitt B, Pratt CM, Schwartz PJ, Veltri EP. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. SurvivalWith Oral d-Sotalol. Lancet 1996;348:7–12.

    Google Scholar 

  14. Connolly SJ, Hallstrom AP, Cappato R, Schron EB, Kuck KH, Zipes DP, Greene HL, Boczor S, Domanski M, Follmann D, Gent M, Roberts RS. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. Eur Heart J 2000;21:2071–2078.

    Google Scholar 

  15. Bigger JT, Jr. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med 1997;337:1569–1575.

    Google Scholar 

  16. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M. Improved survival with an implanted de-fibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996;335:1933–1940.

    Google Scholar 

  17. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–883.

    Google Scholar 

  18. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999;341:1882–1890.

    Google Scholar 

  19. Strickberger SA, Hummel JD, Bartlett TG, Frumin HI, Schuger CD, Beau SL, Bitar C, Morady F. Amiodarone versus implantable cardioverter-defibrillator: Randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia-AMIOVIRT. J AmColl Cardiol 2003;41:1707–1712.

    Google Scholar 

  20. Bänsch D, Antz M, Boczor S, Volkmer M, Tebbenjohanns J, Seidl K, Block M, Gietzen F, Berger J, Kuck KH. Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: The Cardiomyopathy Trial (CAT). Circulation 2002;105:1453–1458.

    Google Scholar 

  21. Kadish A, Quigg R, Schaechter A, Anderson KP, Estes M, Levine J. Defibrillators in nonischemic cardiomyopathy treatment evaluation. Pacing Clin Electrophysiol 2000;23:338–343.

    Google Scholar 

  22. Hohnloser SH, Connolly SJ, Kuck KH, Dorian P, Fain E, Hampton JR, Hatala R, Pauly AC, Roberts RS, Themeles E, Gent M. The defibrillator in acute myocardial infarction trial (DINAMIT) study protocol. Am Heart J 2000;140:735–739.

    Google Scholar 

  23. Hohnloser SH, Klingenheben T, Zabel M. Identification of patients after myocardial infarction at risk of life-threatening arrhythmias. Eur Heart J 1999;1(suppl C):C11–C20.

    Google Scholar 

  24. Schwartz PJ, La Rovere MT, Vanoli E. Autonomic nervous system and sudden cardiac death. Experimental basis and clinical observations for post-myocardial infarction risk stratification. Circulation 1992;85:I77–I91.

    Google Scholar 

  25. Copie X, Hnatkova K, Staunton A, Fei L, Camm AJ, Malik M. Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction. Results of a two-year follow-up study. J AmColl Cardiol 1996;27:270–276.

    Google Scholar 

  26. Hohnloser SH, Franck P, Klingenheben T, Zabel M, Just H. Open infarct artery, late potentials, and other prognostic factors in patients after acute myocardial infarction in the thrombolytic era. A prospective trial. Circulation 1994;90:1747–1756.

    Google Scholar 

  27. Kleiger RE, Miller JP, Krone RJ, Bigger JT, Jr. The independence of cycle length variability and exercise testing on predicting mortality of patients surviving acute myocardial infarction. The Multicenter Postinfarction Research Group. Am J Cardiol 1990;65:408–411.

    Google Scholar 

  28. La Rovere MT, Bigger JT, Jr., Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Re-flexes After Myocardial Infarction) Investigators. Lancet 1998;351:478–484.

    Google Scholar 

  29. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J AmStat Assoc 1958;53:457–481.

    Google Scholar 

  30. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966;50:163–170.

    Google Scholar 

  31. Hinkle LE, Jr., Thaler HT. Clinical classification of cardiac deaths. Circulation 1982;65:457–464.

    Google Scholar 

  32. Antiarrhythmics versus implantable cardioverter (AVID) investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med 1997;337:1576–1583.

    Google Scholar 

  33. Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS, Mitchell LB, Green MS, Klein GJ, O'Brien B. Canadian implantable defibrillator study (CIDS): A randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 2000;101:1297–1302.

    Google Scholar 

  34. Reynolds MR, Josephson ME. MADIT II (second Multicenter Automated Defibrillator Implantation Trial) debate: Risk stratification, costs, and public policy. Circulation 2003;108:1779–1783.

    Google Scholar 

  35. Lynd LD, O'Brien BJ. Cost-effectiveness of the implantable cardioverter defibrillator: A review of current evidence. J Cardiovasc Electrophysiol 2003;14:S99–S103.

    Google Scholar 

  36. Hohnloser SH, Ikeda T, Bloomfield DM, Dabbous OH, Cohen RJ. T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation. Lancet 2003;362:125–126.

    Google Scholar 

  37. Jokinen V, Tapanainen JM, Seppanen T, Huikuri HV. Temporal changes and prognostic significance of measures of heart rate dynamics after acute myocardial infarction in the beta-blocking era. Am J Cardiol 2003;92:907–912.

    Google Scholar 

  38. Kretowski A, Kinalska I. Serum levels of interleukin-18-a potential marker of cardiovascular death-could be determined by genetic predisposition. Circulation 2003;107:e206–e207.

    Google Scholar 

  39. Struthers AD. Careful screening to target interventions to prevent sudden cardiac death. Clin Exp Pharmacol Physiol 2001;28:219–222.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grönefeld, G., Connolly, S.J. & Hohnloser, S.H. The Defibrillator in Acute Myocardial Infarction Trial (DINAMIT): Rationale, Design and Specific Aims. Card Electrophysiol Rev 7, 447–451 (2003). https://doi.org/10.1023/B:CEPR.0000023154.52786.f4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:CEPR.0000023154.52786.f4

Navigation