Comment to ' PCI, ICD, both, or none?'
Comment to PCI, ICD, both, or none?

  • @Khalid Abozguia @Yousef Darrat would you give this man an ICD now?

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    • Thanks @Khalid Abozguia . His EF is 39% (just below 40%), which based on current guidelines make him qualified for ICD (MADIT-II), NYHA-II.

      Is the reason you don't vote for ICD yet because he has been on GDMT for only 2-3 months?

      His is already on Farxiga (added by his PCP). Regardless, MADIT-II was conducted before SGLTI showed mortality benefit. So, it will be interesting to show that SGLTI blunt the benefit added by ICD placement, just curious).

      If so, who long would you wait before you re-check his EF and decide about ICD?

      • MADIT II LVEF < 30%

        guideline now recommend ICD :

        < 35% if NYHA II-III

        or

        < 30 % even if NYHA I

        or

        < 40% + NSVT - MUSTT study recommend VT stim (EP study) - if positive then ICD

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        • Sorry Khalid, I meant 35% (not 40%, but >40 days post MI) and NYHA-II. His EF by MRI is just above that (39%) which with degree of scarring he has makes me wonder if it will not get any better. Last year I had a patient argued with me on his EF of 38% why not implant ICD. It turned out that he will get disability if he gets ICD, but since I didn't implant it, he fired me!

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