Abstract
The multicenter unsustained tachycardia trial (MUSTT) tested the value of electrophysiologically guided antiarrhythmic drug therapy against no therapy in high risk coronary artery disease with poor left ventricular function (LV-EF ≤ 40%) and nonsustained ventricular tachycardia. Risk assessment was performed by testing inducibility of a sustained ventricular tachycardia. The primary endpoint of the study was sudden arrhythmic death or cardiac arrest. Significant information on risk stratification was gathered by the follow-up of patients that were noninducible. Although MUSTT was not a specific ICD trial for primary prevention of SCD the results of the trial revealed that only with ICD back-up—a significant reduction of arrhythmic death or cardiac arrest can be achieved.
EP-guided antiarrhythmic drug treatment had a lower incidence of SCD/CA compared to no treatment (12% versus 25%, p = 0.043, hazard ratio 0.73 after 24 months and 18% versus 32% after 60 months). A subgroup analysis showed that the benefit of antiarrhythmic treatment was only due to ICD implantation. No difference was found between those inducible pts treated exclusively with antiarrhythmic drugs and those who were randomized to no drug treatment. Patients who were not inducible did significantly better than pts who were inducible wether or not treated with antiarrhythmic drugs.
MUSTT results strengthen the data of the MADIT study. They confirm the inducibility testing as the most accurate risk stratifier. MUSST demonstrated the poor value of serial EP drug testing as well as the risk of “stand alone” antiarrhythmic drug treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bigger JT, Fleiss JL, Kleiger R, et al. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation 1984;69:250–258.
Mukharji J, Rude RE, Poole WK, et al. Risk factors for sudden death after acute myocardial infarction: 2-year follow-up. Am J Cardiol 1984;54:31–36.
Buxton AE, Fisher JO, Josephson ME, et al. Prevention of sudden death in patients with coronary artery disease: The Multicenter Unsustained Tachycardia Trial (MUSTT). Prog Cardiovasc Dis 1993;36:215–226.
Mason JW, for the ESVEM Investigators. A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmic efficacy for ventricular tachyarrhythmias. N Engl J Med 1993;329:445–451.
Moss AJ, Hall WJ, Cannom DS, et al., for the Multicenter Automatic Defibrillator Implantation Trial Investigators. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996;335:1933–1940.
Kowey PR, Taylor JE, Marinchak RA, et al. Does programmed stimulation really help in the evaluation of patients with nonsustained ventricular tachycardia? Results of a meta-analysis. Am Heart J 1992;123:481–489.
Wilber DJ, Olshansky B, Moran JF, Scanlon PJ. Electrophysiologic testing and nonsustained ventricular tachycardia: use and limitations in patients with coronary artery disease and impaired ventricular function. Circulation 1990;82:350–358.
Wilber D, Olshansky B, Moran J, et al. Electrophysiological testing and nonsustained ventricular tachycardia. Circulation 1991;84:2–21.
Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991;324:781–788.
Julian DG, Camm AJ, Frangin G, et al., for the European Myocardial Infarct Amiodarone Trial Investigators. Randomized trial of the effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 1997;349:667–674.
Cairns JA, Connolly SJ, Roberts R, et al., for the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Randomized trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Lancet 1997;349: 675–682.
Singh SN, Fletcher RD, Fisher SG, et al., for the Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure (CHF-STAT). Amiodarone in patients with congestive heart failure and asymtomatic ventricular arrhythmia (CHF-STAT). N Engl J Med 1995;333:77–82.
Simson MB. Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation 1981;64:235–242.
Bigger, JT. Primary prevention of sudden cardiac death using implantable cardioverter-defibrillators. In: Singer I, ed. Implantable cardioverter-Defibrillator. Armonk, NY: Futura Publishing Company, 1994:515–546.
Buxton AE, Lee KL, Di Carlo L, et al. Nonsustained ventricular tachycardia in coronary artery disease: Relation to inducible sustained ventricular tachycardia. Ann Intern Med 1996;125:35–39.
Bigger JT, for the CABG Patch Trial Investigators. Prophylactic use of implanted cardiac defibrillators in patients at risk for ventricular arrhythmias after coronary artery bypass graft surgery. N Engl J Med 1997;337:1569–1575.
Naccarelli GV, Wolbrette DL, Dell'Orfano JT, et al. A decade of clinical trial developments in postmyocardial infarction, congestive heart failure, and sustained ventricular tachyarrhythmia patients: From CAST to AVID and beyond. J Cardiovasc Electrophysiol 1998;9:864–891.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Klein, H.U., Reek, S. The MUSTT Study: Evaluating Testing and Treatment. J Interv Card Electrophysiol 4 (Suppl 1), 45–50 (2000). https://doi.org/10.1023/A:1009862028599
Issue Date:
DOI: https://doi.org/10.1023/A:1009862028599