European Heart Journal Advance Access originally published online on March 18, 2005
European Heart Journal 2005 26(8):762-769; doi:10.1093/eurheartj/ehi188
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Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment era
1Division of Cardiology, Department of Internal Medicine, University of Oulu, PO Box 5000 (Kajaanintie 50), FIN-90014, Oulu, Finland
2Deutsches Herzzentrum und 1 Medizinische Klinik der Technischen Universität München, Munich, Germany
Received 29 August 2004; revised 17 January 2005; accepted 20 January 2005; online publish-ahead-of-print 18 March 2005.
* Corresponding author. Fax: +358 8 315 5599. E-mail address: timo.makikallio{at}oulu.fi
Aims Current treatment may have changed the risk profiles of survivors of acute myocardial infarction (AMI). We evaluated the utility of Holter-based risk variables in the prediction of sudden cardiac death (SCD) among survivors of AMI treated with modern therapy.
Methods and results A total of 2130 AMI patients (mean age 59±10 years) were included. The patients were treated with modern therapeutic strategies, for example, 94% were on ß-blocking therapy and 70% underwent coronary revascularization. Various risk parameters from Holter monitoring were analysed. During a median follow-up of 1012 days (interquartile range: 750–1416 days), cardiac mortality was 113/2130, including 52 SCDs. All Holter variables predicted the occurrence of SCD (P<0.01), but only reduced post-ectopic turbulence slope (TS) (P<0.001) and non-sustained ventricular tachycardia (P<0.01) remained as marked SCD predictors after adjustment for age, diabetes, and ejection fraction (EF). In a subgroup analysis, none of the Holter variables predicted SCD among those with an EF 
0.35, but many variables predicted SCD among those with an EF >0.35, particularly TS (hazard ratio 5.9; 95% CI 2.9–11.7, P<0.001).
Conclusion Among the post-AMI patients treated according to the current guidelines, the incidence of SCD is low. Various Holter variables still predict the occurrence of SCD, particularly among the patients with preserved left ventricular function.
Key Words: Death • Sudden • Myocardial infarction • Heart rate • Survival
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