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European Heart Journal 1989 10(1):24-31;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Relative prognostic value of clinical, biochemical, echocardiographic and haemodynamic variables in predicting in-hospital and one-year cardiac mortality after acute myocardial infarction

L. A. PIèARD1,, A. ALBERT2, J.-P. CHAPELLE3, J. CARLIER1 and H. E. KULBERTUS1

1Departments of Cardiology Liège Belgium
2Medical Computing Liege Belgium
3Clinical Chemistry University Hospital Liege Belgium

Received 29 February 1988; revised 15 August 1988; .

Address for reprints: Luc A. Pièard, MD, Universitè de Liège, service de Cardiologie, C.H.U, Sart-Tilman, B-4000 Liège, Belgium

Abstract

This study examined the relative value of clinical, biochemical, echocardiographic and haemodynamic variables, obtained early after acute myocardial infarction in predicting in-hospital and one-year cardiac mortality in 66 consecutive patients. Clinical examination and cross-section echocardiography were obtained in all 66 patients. An echocardiographic score index was calculated by grading wall motion from 0 to 5 in each of 16 left ventricular segments. Right-sided cardiac catheterization was performed soon after admission in 51 patients. Cardiac enzymes were measured every fourth hour in all patients and peak levels were identified in 55. During the follow-up of one year, 14 patients died of cardiac causes, seven of them during hospital stay; three patients died of a non-cardiac cause and were excluded from analysis. The echocardiographic score index was the best predictor of cardiac death and survival (X 2 = 35), followed by Killip class on admission (X 2 = 22), stroke volume index (X 2 = 17) and a biochemical risk index (X 2 = 11). Stepwise logistic discriminant analysis performed in the patients in whom all variables were obtained resulted in three independent prognostic variables: the echocardiographic score index, systemic vascular resistance at the time of catheterization and the development of infarct expansion. High- and low-risk patients are well identified by echocardiography in the acute phase of myocardial infarction.

Key Words: Acute myocardial infarction • cross-sectional echocardiography • haemodynamics • infarct size


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