Psychosocial interviews with 2320 male survivors of acute myocardial infarction, participants in the beta-Blocker Heart Attack Trial, permitted the definition of two variables strongly associated with an increased three-year mortality risk. With other important prognostic factors controlled for, the patients classified as being socially isolated and having a high degree of life stress had more than four times the risk of death of the men with low levels of both stress and isolation. An inverse association of education with mortality in this population reflected the gradient in the prevalence of the defined psychosocial characteristics. High levels of stress and social isolation were most prevalent among the least-educated men and least prevalent among the best-educated. The increase in risk associated with stress and social isolation applied both to total deaths and to sudden cardiac deaths and was noted among men with both high and low levels of ventricular ectopy during hospitalization for the acute infarction.

To assess the role of ventricular premature beats in influencing mortality of coronary patients, 1739 men with prior myocardial infarction were monitored for ectopic activity for one hour at a standard base-line examination, and followed for mortality for periods up to four years (average, 24.4 months). Analyses of survival taking into account other important prognostic variables establish that the presence of complex premature beats (R on T, runs of 2 or more, multiform or bigeminal premature beats) in the monitoring hour is associated with a risk of sudden coronary death three times that of the men free of complex ventricular premature beats. The corresponding risk of death from any cause is twice that of men without such complex beats in the hour. These arrhythmias make an independent contribution to increased risk of death that persists over the length of this observation period.

tended to develop 5-year mortality rates. Accumulation of a total of 349 deaths, 149 of them sudden (deaths within minutes in the absence of symptoms or signs of acute MI), permits both examination of course of disease over the longer period and more detailed study of the role of specified qualitative features of the ventricular premature complexes in relation to risk of sudden death. MethodsOver a period of almost 4 years (March 1972 through December 1975, 2155 CHD patients were identified from a population of 120,000 men ages 35-74 years, insured in HIP, a prepaid group-practice plan providing comprehensive medical services. Standard baseline observations included interviews to establish personal characteristics and medical history, physical examination and laboratory determinations, a 12-lead ECG and 1 hour of single-lead ECG monitoring recorded on tape. A baseline examination was performed in 87% of the men identified as potential study subjects from case-finding procedures. Of those examined, 83% satisfied the study criteria for CHD12 and entered the follow-up phase of the study. Of these, 1739 men had had at least one MI before the baseline date and 416 had had unequivocal effort angina in the absence of historical or ECG evidence of MI.Computer processing of the monitoring tapes produced writeouts on ECG paper of all possibly abnormal beats. Double reading these sections by trained technicians and physicians then provided the basis for classification of patients by ventricular ectopic activity during the monitoring hour. Details of the method and data on validation have been published.7, 13 Follow-up of all patients is now complete, and mortality status as of the last observation due before April 1, 1978 is known for all patients. The final data, presented for the MI patients in this report, are based on an average observation period of 3.5 years. Patients have been followed for mortality up to periods of 5.5 years,

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