Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Error: Please enter a valid sender email address. Example: email@example.com CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Error: Please enter your name Error: Please enter your email address Error: Please enter a valid recipient email address. Example:firstname.lastname@example.org Thank you! Your email has been sent to: The recipient(s) will receive an email message that includes a link to the selected article. Recipients may need to check their spam filters or confirm that the address is safe. Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@email.mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Musikantow D, Koruth J. Musikantow D, Koruth J Musikantow, Daniel, and Jacob Koruth. "VEST Trial." Hurst's the Heart Updates, 24 May 2016. McGraw-Hill, New York, NY, 2016. AccessCardiology. http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424349§ionid=189592056 MLA Citation Musikantow D, Koruth J. Musikantow D, Koruth J Musikantow, Daniel, and Jacob Koruth.. "VEST Trial." Hurst's the Heart Updates Fuster V. Fuster V Fuster, Valentin. New York, NY: McGraw-Hill, 2016, http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424349§ionid=189592056. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top VEST Trial by Daniel Musikantow, MD; Jacob Koruth, MD, + +Update to Chapter 40: ST-Segment Elevation Myocardial Infarction Study Summary + +Internal cardiac defibrillators have been shown to be effective at preventing arrhythmic sudden cardiac death (SCD) in patients with a history of myocardial infarction (MI) and reduced ejection fraction (EF); however, trials in the early post-MI period have been negative. The use of wearable cardiac defibrillators (WCDs) was evaluated in a multicenter, randomized trial in patients with an MI and EF <35% within 7 days of their hospital discharge. In total, 1524 patients were randomized to receive a WCD + goal-directed medical therapy, with 778 patients assigned to medical therapy alone (controls). Baseline characteristics were similar between groups. Those assigned to the WCD group wore their device for an average of 14.1 hours per day. In an intention-to-treat analysis at 3 months follow-up, 1.6% in the WCD arm and 2.4% of controls had experienced SCD (P = 0.18) (see accompanying Hurst’s Central Illustration). In the WCD group, the any-case death rate was significantly decreased (3.1% vs. 4.9% in the control arm; P = .04), and <1.4% of patients received an appropriate therapy. + Wearable Cardiac Defibrillators in the Early Post-MI Period Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) Commentary + +Study Strengths: For over the past decade, the WCD has been used clinically in patients who are early post-MI with reduced EF. This trial represents the only randomized trial to date that examines the efficacy of the WCD in the prevention of SCD. In this trial, patients in both arms received high rates of contemporary goal directed medical therapy. The low event and mortality rates in this study support the impact of contemporary post–MI therapies. +Study Limitations: This study was not blinded, and compliance was low overall in the WCD arm with patients wearing their devices for a mean of 14.1 hours per day. Furthermore, there were low rates of the primary endpoint with only 25/1524 patients in the WCD arm and 19/778 in the control arm reaching the endpoint of SCD. These low event and mortality rates in this study support the impact of contemporary post–MI therapies. Unexpectedly, more patients in the control arm experienced stroke related deaths which contributed to the mortality advantage in the WCD group. +Next Steps/Clinical Perspective: Although concerns such as low event rates, limited compliance and possible misclassification of SCD may explain the lack of reduction in the primary endpoint, this trial should be interpreted as having failed to reduce SCD. While this study included all patients with decreased EF in the post MI period, further investigation may better identify a higher-risk subset that may benefit from interim use of a WCD. This along with a cost-effectiveness analysis will be needed to determine its role in this population.