2018Arrhythmias & devicesAcute coronary syndromes2302 patients

VEST

Therapy group: Wearable defibrillator · Therapy: Wearable cardioverter-defibrillator after MI with LVEF ≤35%

In patients with low ejection fraction after myocardial infarction, the wearable defibrillator did not significantly reduce arrhythmic death, though all-cause mortality was lower, with limited real-world device adherence.

Published in N Engl J Med (2018)

Question: Does a wearable cardioverter-defibrillator reduce arrhythmic death in the early months after an acute myocardial infarction with a low ejection fraction, a period when an implantable defibrillator is contraindicated?
Design: Randomized, open-label trial (single masking per the registry) with 2:1 allocation, enrolling 2302 participants; those in the device group wore the device a median of 18.0 hours per day.
Population: Patients with a recent acute myocardial infarction and an ejection fraction of 35% or less.
Intervention: Wearable cardioverter-defibrillator plus guideline-directed therapy (device group, n = 1524).
Control: Guideline-directed therapy alone (control group, n = 778).
Primary outcome: Composite of sudden death or death from ventricular tachyarrhythmia (arrhythmic death) at 90 days.
Results: Arrhythmic death occurred in 1.6% of the device group and 2.4% of the control group (relative risk 0.67; 95% CI 0.37 to 1.21; P=0.18). All-cause death was 3.1% versus 4.9% (relative risk 0.64; 95% CI 0.43 to 0.98; uncorrected P=0.04).
Safety: Twenty participants in the device group (1.3%) received an appropriate shock and 9 (0.6%) received an inappropriate shock. Of the 48 who died in that group, 12 were wearing the device at the time of death.
Conclusion: The wearable cardioverter-defibrillator did not significantly reduce arrhythmic death compared with control in patients with a recent myocardial infarction and low ejection fraction.
Why it matters: The neutral primary result weakened the case for routine use of the wearable defibrillator after myocardial infarction, although inconsistent device wear and the lower all-cause mortality seen in a secondary analysis kept the debate open about its role in selected patients.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 14, 2026

Sources

Original publication on PubMed (PMID 30280654) ↗Wearable Cardioverter-Defibrillator after Myocardial Infarction.
Journal article (DOI) ↗
ClinicalTrials.gov record (NCT01446965) ↗

Videos explaining it

ESC TV at ACC.18 - Results of the Vest Prevention of Early Sudden Death Trial (VEST)

ESC · European Society of Cardiology ↗2:15Video page

Source: European Society of Cardiology · YouTube
Date: 10 Mar 2018
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: None

All videos explaining it · 2 videos

2:15

ESC TV at ACC.18 - Results of the Vest Prevention of Early Sudden Death Trial (VEST)

Source: European Society of Cardiology · YouTube
Date: 10 Mar 2018
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: None

2:15

ESC TV at ACC.18 - Perspective on Results of the Vest Prevention of Early Sudden Death Trial (VEST)

Source: European Society of Cardiology · YouTube
Date: 10 Mar 2018
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: None

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