A 58-year-old man undergoes primary PCI for anterior STEMI. At 3-week follow-up, echocardiography shows LVEF of 35%. He is on optimal medical therapy. When should primary prevention ICD be considered?
- A Reassess LVEF after 40 days on medical therapy; implant if EF remains ≤35% ✓
- B Implant ICD now
- C Reassess LVEF at 6 months; implant if EF ≤35%
- D No indication for ICD with EF 35%
Correct answer: A. Reassess LVEF after 40 days on medical therapy; implant if EF remains ≤35%
Explanation
ACC/AHA guidelines recommend waiting at least 40 days (ESC says 90 days) after MI before ICD implantation for primary prevention, as EF may recover with revascularization and medical therapy. If EF remains ≤35% on optimal medical therapy after this waiting period, ICD is indicated to prevent sudden cardiac death.
Reference: Braunwald's Heart Disease, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.