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European Heart Journal 1987 8(12):1272-1280;
Copyright © 1987 by the European Society of Cardiology.
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© 1987 The European Society of Cardiology

Sub-grouping of post myocardial infarction patients according to their one-year death risk

J.-P. BOISSEL, J.-C. PEYRIEUX and The EPSIM RESEARCH GROUP*

Unité de pharmacologie Clinique, Höpital Neuro-Cardiologique 162 Avenue Lacassagne 69424, Lyon Cédex 3, France

Received 7 November 1986; revised 8 May 1987; .

J. P. Boissel, Unité de Pharmacologie Clinique, Hôpital Neuro-Cardiologique, 1162 Avenue Lacassague, 69424, Lyon Cedex 3, France.

This study was undertaken to investigate whether sub-grouping post myocardial infarction (M1) patients with various risks of death was possible. Data on 6900 consecutive patients with clinical sympstoms of acute M1 were collected prospectively within 48 h of their admission. Vital status at one year was obtained for all but 264 (3.8%) A total of 476 (7.2%) patients died within the first 7 days. Correlation of baseline historical, demographic, biological and ECG variables with total mortality was first investigated with univariate analysis. Fifty-three secondary risk factors (SRF) were identified, based on: (1) a P value for comparison between dead and alive lower than 0.02; (2) a minimum number of 100 subjects in each cell of the four-fold table. Based on this set of SRFs, two approaches were used to investigate the distribution of patients still alive at 8 days regarding the one-year mortality risk, and to assign them in three sub-groups of equal size of increasing risk compared with a logistic regression. Both approaches gave consistent findings. One third of the patients with the lowest risk of death within 12 months had an individual risk between 0% and 8%; the average mortality was 5–6% which represented 10.7% of the total number of deaths. The third swith the highest individual risks had an individual risks had an individual risk ranging from 17–19% to 100%, with an average mortality of 35–37%; they accounted for 66–67% of the total number of deaths. Thus it seems possible to identify sub-groups of post M1 patients with either low risk, or very high risk, or very high risk. Only the latter deserve attention for secondary prevention.

Key Words: Prognosis • myocardial infarction • one-year risk


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