A 55-year-old man with anterior STEMI and EF 35% 3 weeks later is being evaluated. The MADIT-II trial informs the decision to implant an ICD. What is the current ACC/AHA guideline recommendation for ICD implantation in this scenario?
- A ICD implant if EF remains ≤35% at 6 weeks, despite optimal medical therapy, and patient on GDMT for ≥3 months ✓
- B ICD implant immediately at hospital discharge
- C ICD implant only if EF < 25% at 3 months
- D ICD implant requires prior electrophysiology study showing inducible VT
Explanation
Current ACC/AHA guidelines (based on MADIT-II and SCD-HeFT) recommend ICD implantation for primary prevention of sudden cardiac death in ischemic cardiomyopathy with EF ≤35% only after at least 3 months of optimally tolerated guideline-directed medical therapy (GDMT) and at least 40 days post-MI. This waiting period is critical because EF often improves significantly with revascularization and optimal therapy (ACEi/ARB, beta-blocker, MRA). Immediate implant at discharge is not supported; waiting allows EF recovery assessment and avoids unnecessary device implantation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.