Implantation of a defibrillator early after myocardial infarction (MI) in high-risk patients reduced the risk of sudden cardiac death, but there was a reciprocal increase in the risk of nonsudden cardiac death. Overall mortality was not affected by early defibrillator implantation, and therefore this intervention cannot be recommended after MI in high-risk patients. Early after MI Implantation of a defibrillator early after myocardial infarction (MI) in high-risk patients reduced the risk of sudden cardiac death, but there was a reciprocal increase in the risk of nonsudden cardiac death. Despite the general improvement in outcomes among survivors of acute myocardial infarction the rate of death, including sudden cardiac death, remains highest in the weeks after the event. 1 , 2 Sudden cardiac death due to ventricular tachyarrhythmias accounts for approximately 20 to 50% of all deaths in this population. 3 – 5 Therefore, prevention of sudden cardiac death after myocardial infarction remains an important goal. With the exception of beta-blockers, antiarrhythmic drugs do not reduce this risk. Several randomized trials have shown that an implantable cardioverter–defibrillator (ICD) can reduce mortality both among patients who have had sustained ventricular tachyarrhythmias 6 and among selected patients . . .