Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Risk stratification after myocardial infarction
A reappraisal in the era of thrombolysis
*Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon Montchat Lyon, France
Unité de Pharmacologie Clinique Lyon, France
Centre de Médecine Nucléaire, Lyon Monchat Lyon, France
Centre Hospitalier Saint Joseph-Saint Luc Lyon, France
¶Hôpital de la Croix Rousse Lyon, France
revised 20 June 1996; accepted 1 July 1996.
Correspondence: Paul Touboul, MD, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon Montchat, 69394 Lyon Cédex 3, France
Abstract
Objectives The present study was performed to evaluate whether the modalities of risk stratification after myocardial infarction were still operative in the thrombolytic era.
Background Prediction of fatal events in the aftermath of myocardial infarction relies on tests which aim to assess myocardial function, residual ischaemia and propensity for ventricular arrhythmias. Recent data on improved myocardial infarction prognosis have led to the view that risk stratification needs to be updated.
Methods In this multicentre, prospective study, 471 acute myocardial infarction patients, 45% of whom were given thrombolytic therapy, were enrolled from the 10th day and underwent all or part of the following tests: exercise test, radionuclide ventriculography (resting and exertional ejection fraction), Holter monitoring, signal-averaged electrocardiography and programmed electrical stimulation. Univariate and multivariate analyses were performed to identify predictors of mortality.
Results One year and long-term (mean follow-up 31·4 months) mortality rates were 5·5% and 8·4% respectively. Prediction of mortality was assessed and the role of the following variables was thus determined: age over 56 years (P=0·01), previous coronary attacks (P>0·001), history of heart failure (P>0·001), early heart failure after myocardial infarction (P=0·017), maximum workload of lest than 120 W at exercise test (P=0·014), ineligibility to perform exercise (P=0·002), depressed left ventricular ejection fraction (P=0·013), late potentials as identified using 50 Hz high pass filtering (P=0·012), mean night-time cycle length of less than 750 ms (P0·001), standard deviation of day time RR intervals of less than 100 ms (P=0·04), the last two measures reflecting heart rate variability. In this population, neither ventricular ectopic activity nor inducibility of sustained monomorphic ventricular tachycardia at electrophysiological study carried any prognostic significance. Multivariate analyses showed that decreased heart rate variability, presence of late potentials and low ejection fraction (>30%) made an independent contribution to the survival models.
Conclusion In the current context of management of acute coronary patients, the basis for risk stratification after myocardial infarction remain roughly unchanged.
Key Words: Myocardial infarction • prognosis • ejection fraction • heart rate variability • signal averaged ECG
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1179 - 1199. [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention Circulation, September 30, 2008; 118(14): 1497 - 1518. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sciagra, G. Parodi, A. Pupi, A. Migliorini, R. Valenti, G. Moschi, G. M. Santoro, G. Memisha, and D. Antoniucci Gated SPECT Evaluation of Outcome After Abciximab-Supported Primary Infarct Artery Stenting for Acute Myocardial Infarction: The Scintigraphic Data of the Abciximab and Carbostent Evaluation (ACE) Randomized Trial J. Nucl. Med., May 1, 2005; 46(5): 722 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Bauer, P. Guzik, P. Barthel, R. Schneider, K. Ulm, M. A. Watanabe, and G. Schmidt Reduced prognostic power of ventricular late potentials in post-infarction patients of the reperfusion era Eur. Heart J., April 2, 2005; 26(8): 755 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Leoncini, F. Bellandi, R. Sciagra, M. Maioli, A. Toso, A. Coppola, S. Sestini, A. Mennuti, R. P. Dabizzi, and A. Pupi Gated SPECT Evaluation of the Relationship Between Admission Troponin I, Myocardial Salvage, and Functional Recovery in Acute Myocardial Infarction Treated by Abciximab and Early Primary Angioplasty J. Nucl. Med., May 1, 2004; 45(5): 739 - 744. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Berton, R Cordiano, R Palmieri, F Cucchini, R de Toni, and P Palatini Microalbuminuria during acute myocardial infarction; a strong predictor for 1-year mortality Eur. Heart J., August 2, 2001; 22(16): 1466 - 1475. [Abstract] [PDF]
|
|
|
|
|
|
C. Schmitt, P. Barthel, G. Ndrepepa, J.u. Schreieck, A. Plewan, A. Schomig, and G. Schmidt Value of programmed ventricular stimulation for prophylactic internal cardioverter-defibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1901 - 1907. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Abboud, J. Hir, I. Eisen, A. Cohen, and W. Markiewicz Long-term Value of Exercise Testing After Acute Myocardial Infarction: Influence of Thrombolytic Therapy Chest, February 1, 2000; 117(2): 556 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Hohnloser, T. Klingenheben, M. Zabel, M. Schopperl, and O. Mauss Prevalence, characteristics and prognostic value during long-term follow-up of nonsustained ventricular tachycardia after myocardial infarction in the thrombolytic era J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1895 - 1902. [Abstract] [Full Text] [PDF]
|
|