Efficacy of Implantable Defibrillator Therapy After a Myocardial Infarction

NCT ID: NCT00673842

Last Updated: 2025-05-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

700 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-04-18

Study Completion Date

2024-10-31

Brief Summary

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This study will assess whether an implantable defibrillator will increase the likelihood of survival in patients who have had a heart attack, have abnormal test results from a 24 hour heart monitor, and who have low normal heart function.

Detailed Description

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The REFINE ICD trial will assess whether prophylactic ICD therapy, guided by non-invasive risk assessment tools, reduces mortality in MI survivors with better-preserved LV function.

Conditions

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Myocardial Infarction Sudden Death

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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ICD + Usual Care

Implantable Cardioverter Defibrillator + Usual Care

Group Type EXPERIMENTAL

Implantable Cardioverter Defibrillator + Usual Care

Intervention Type DEVICE

Any Medtronic approved single chamber or dual chamber implantable cardioverter defibrillator (ICD)

Usual Care

Usual post-MI care

Group Type ACTIVE_COMPARATOR

Usual care

Intervention Type OTHER

Usual post-MI care

Interventions

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Implantable Cardioverter Defibrillator + Usual Care

Any Medtronic approved single chamber or dual chamber implantable cardioverter defibrillator (ICD)

Intervention Type DEVICE

Usual care

Usual post-MI care

Intervention Type OTHER

Other Intervention Names

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Implantable Cardioverter Defibrillator ICD Standard medical therapy alone

Eligibility Criteria

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Inclusion Criteria

* 18 - 80 years old at time of consent
* History of MI ≥ 2 months prior to screening based on ESC/ACCF/AHA/WHF criteria (both STEMI and NSTEMI subjects are eligible)
* Appropriate post-MI management including revascularization where indicated
* No contra-indication for transvenous ICD placement (e.g., mechanical tricuspid valve, known vascular access problems, active sepsis, etc.)
* LVEF 36% - 50% measured at least 40 days after a confirmed MI ≥ 3 months after coronary angioplasty or coronary bypass surgery and within the following time windows:

* LVEF ≤ 7 months of screening visit if index MI was ≤ 1 year of enrolment
* LVEF ≤ 13 months of screening visit if index MI was \> 1 \& \< 3 years of enrolment
* LVEF ≤ 25 months of screening visit if index MI was ≥ 3 years of enrolment
* Proven, necessary or appropriate medications (e.g. beta-blocker, ACE inhibitor / ARB, statin, and anti-platelet)
* In normal sinus rhythm (ECG documented) ≤ 8 weeks prior to the screening Holter
* Written informed consent
* Able and willing to complete the screening Holter, including the six-minute hall walk

Additional inclusion criterion (eligibility for randomization).

* Abnormal HRT \& TWA (core lab interpretation) on Holter performed at least 2 months after the index MI and the specified time after coronary revascularization
* In normal sinus rhythm (ECG documented) within 8 weeks prior to the screening Holter
* In normal sinus rhythm for ≥ 18 hours of the 24 hr screening Holter as determined by the study Holter Core Lab

Exclusion Criteria

* Use of antiarrhythmic drugs
* Clinical indication for permanent pacemaker or a cardiac resynchronization device
* Clinical indication for an ICD or cardiac resynchronization ICD
* Prior implantation of a pacemaker, ICD, or Cardiac Resynchronization device
* Any condition, in the investigator's judgment, that would limit life expectancy to \< 12 months
* Chronic renal failure (hemodialysis or peritoneal dialysis)
* Active ischemia that is amenable to revascularization if not previously revascularized
* Participation in another trial that may interfere with the REFINE ICD results.
* Pregnancy
* Inability to comply with the follow-up schedule
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Alberta Innovation and Science

OTHER

Sponsor Role collaborator

Medtronic

INDUSTRY

Sponsor Role collaborator

GE Healthcare

INDUSTRY

Sponsor Role collaborator

Cardiac Arrhythmia Network of Canada

OTHER

Sponsor Role collaborator

Accelerating Clinical Trials Consortium

OTHER

Sponsor Role collaborator

University of Calgary

OTHER

Sponsor Role lead

Responsible Party

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Dr. Derek Exner

Professor and Canada Research Chair in Cardiovascular Clinical Trials

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Derek V Exner, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Locations

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Heart Center Research LLC

Huntsville, Alabama, United States

Site Status

Colorado Heart and Vascular

Lakewood, Colorado, United States

Site Status

James A Haley Veterans' Center

Tampa, Florida, United States

Site Status

The Heart Group/Deaconess

Evansville, Indiana, United States

Site Status

Iowa Heart Center

West Des Moines, Iowa, United States

Site Status

Delmarva Heart Foundation

Salisbury, Maryland, United States

Site Status

Beth Israel Deaconess

Boston, Massachusetts, United States

Site Status

Washington University Medical School

Saint Louis, Michigan, United States

Site Status

St. John Providence Hospital

Southfield, Michigan, United States

Site Status

Lester E Cox Medical Center

Springfield, Missouri, United States

Site Status

The Valley Hospital

Ridgewood, New Jersey, United States

Site Status

Associated Cardiovascular Consultants/Lourdes Cardiology Services

Voorhees Township, New Jersey, United States

Site Status

North Shore LIJ

New York, New York, United States

Site Status

New York Presbyterian Hospital

New York, New York, United States

Site Status

Northeast Ohio Cardiovascular Specialists

Akron, Ohio, United States

Site Status

The Lindner Research Center

Cincinnati, Ohio, United States

Site Status

Bethesda North Hospital

Cincinnati, Ohio, United States

Site Status

Cleveland Clinic

Cleveland, Ohio, United States

Site Status

The Ohio State University

Columbus, Ohio, United States

Site Status

Doylestown Cardiology

Doylestown, Pennsylvania, United States

Site Status

University of Pittsburgh Medical Center UPMC Presbyterian

Pittsburgh, Pennsylvania, United States

Site Status

Geisinger Wyoming Valley Medical Center

Wilkes-Barre, Pennsylvania, United States

Site Status

Greenville Hospital System

Greenville, South Carolina, United States

Site Status

St. Thomas Research Institute

Nashville, Tennessee, United States

Site Status

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status

Amarillo Heart Group

Amarillo, Texas, United States

Site Status

University of Virginia

Charlottesville, Virginia, United States

Site Status

Centra Medical Group

Lynchburg, Virginia, United States

Site Status

Heart Clinics Northwest

Spokane, Washington, United States

Site Status

UZ Leuven - Campus Gasthuisberg

Leuven, , Belgium

Site Status

Libin Cardiovascular Institute of Alberta

Calgary, Alberta, Canada

Site Status

Royal Alexandra Hospital

Edmonton, Alberta, Canada

Site Status

University of Alberta Hospital

Edmonton, Alberta, Canada

Site Status

Fraser Clinical Trials

New Westminster, British Columbia, Canada

Site Status

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status

St. Paul's Hospital/Providence Health Care

Vancouver, British Columbia, Canada

Site Status

Victoria Cardiac Arrhythmia Trials

Victoria, British Columbia, Canada

Site Status

St. Boniface Hospital

Winnipeg, Manitoba, Canada

Site Status

Cardio 1

Winnipeg, Manitoba, Canada

Site Status

New Brunswick Heart Centre

Saint John, New Brunswick, Canada

Site Status

Queen Elizabeth II Health Sciences Center

Halifax, Nova Scotia, Canada

Site Status

Cambridge Cardiac Care Centre

Cambridge, Ontario, Canada

Site Status

Hamilton Health Sciences Centre

Hamilton, Ontario, Canada

Site Status

University of Western Ontario

London, Ontario, Canada

Site Status

Southlake

Newmarket, Ontario, Canada

Site Status

Ottawa Heart Institute

Ottawa, Ontario, Canada

Site Status

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status

Toronto General Hospital

Toronto, Ontario, Canada

Site Status

Montreal Heart Institute

Montreal, Quebec, Canada

Site Status

CHUM

Montreal, Quebec, Canada

Site Status

McGill University Health Centre

Montreal, Quebec, Canada

Site Status

Centre Hospitalier Universitaire de Sherbrooke (CHUS)

Sherbrooke, Quebec, Canada

Site Status

Centre Hospitalier Universitaire Regional de Trois-Rivieres (CHRTR)

Trois-Rivières, Quebec, Canada

Site Status

Prairie Vascular Research Network

Regina, Saskatchewan, Canada

Site Status

Royal University Hospital

Saskatoon, Saskatchewan, Canada

Site Status

Quebec Heart Institute

Laval, , Canada

Site Status

HUCH Helsinki University Central Hospital

Helsinki, , Finland

Site Status

University of Oulu

Oulu, , Finland

Site Status

CHRU Brest - Hôpital de la Cavale Blanche

Brest, , France

Site Status

Hôpital Guillaume et René Laënnec - CHU de Nantes

Nantes, , France

Site Status

Clinique Pasteur

Toulouse, , France

Site Status

Universitätsmedizin Göttingen Georg-August-Universität

Göttingen, , Germany

Site Status

Zala Megyei Kórház

Zalaegerszeg, , Hungary

Site Status

Azienda Ospedaliera Papa Giovanni XXIII

Bergamo, , Italy

Site Status

Policlinico Sant' Orsola - Malpighi

Bologna, , Italy

Site Status

Fondazione IRCCS Policlinico San Matteo

Pavia, , Italy

Site Status

Oslo Universitetssykehus Rikshospitalet

Oslo, , Norway

Site Status

King Saud University

Riyadh, , Saudi Arabia

Site Status

Slovak Medical University in Bratislava

Bratislava, , Slovakia

Site Status

Unitas Hospital

Centurion, , South Africa

Site Status

Hospital General Universitario de Alicante (HGUA)

Alicante, , Spain

Site Status

Hospital Universitario Clinic de Barcelona

Barcelona, , Spain

Site Status

Hospital Universitario La Paz

Madrid, , Spain

Site Status

Hospital Universitario 12 de Octubre

Madrid, , Spain

Site Status

Hospital Universitario La Paz

Madrid, , Spain

Site Status

Universitetssjukhuset Örebro

Örebro, , Sweden

Site Status

Liverpool Heart and Chest Hospital

Liverpool, , United Kingdom

Site Status

Great Western Hospital NHS Trust

Swindon, , United Kingdom

Site Status

Countries

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United States Belgium Canada Finland France Germany Hungary Italy Norway Saudi Arabia Slovakia South Africa Spain Sweden United Kingdom

References

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Perkiomaki J, Exner DV, Piira OP, Kavanagh K, Lepojarvi S, Talajic M, Karvonen J, Philippon F, Junttila J, Coutu B, Huikuri H. Heart Rate Turbulence and T-Wave Alternans in Patients with Coronary Artery Disease: The Influence of Diabetes. Ann Noninvasive Electrocardiol. 2015 Sep;20(5):481-7. doi: 10.1111/anec.12244. Epub 2015 Jan 15.

Reference Type DERIVED
PMID: 25589197 (View on PubMed)

Related Links

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Other Identifiers

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21721

Identifier Type: -

Identifier Source: org_study_id

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