The role of ventricular ectopic beats (VEBs) in identifying patients who die of cardiac cause in the posthospital phase of myocardial infarction was evaluated in 940 patients who survived an acute coronary event. Six-hour Holter ECG recordings were obtained before hospital discharge, and VEBs were classified as complex (bigeminal, multiform, repetitive or R on T), simple (one or more VEBs that did not have complex patterns), or not present. Patients were followed 1-60 months (average 36 months) and cardiac mortality was categorized as sudden (less than or equal to 1 hour) or nonsudden (greater than 1 hour) among 98 witnessed cardiac deaths. Complex VEBs were associated with a significantly increased cardiac death rate, but did not discriminate between sudden and nonsudden death. Simple VEBs were associated with a 3-year cardiac mortality rate intermediate between those with complex and those with no VEBs. The relationship between complex VEBs and cardiac mortality was independent of 10 relevant clinical variables.

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SUMMARY A prospective postinfarction follow-up study was used to identify subsets of patients with different survival patterns. Nine hundred forty patients who survived the hospital phase of an acute myocardial infarction were followed for 12-60 months. During the 5-year follow-up, 115 mortality; and 2) to use survivorship modeling to identify and describe subsets of patients with different survival patterns. Methods PopulationBetween January 1, 1973 and December 31, 1976, 1299 Monroe County residents younger than 66 years of age entered coronary care units in two Rochester community hospitals with a definite or probable acute MI and survived hospitalization. From this population, 978 patients (798 men and 180 women) were enrolled with physician and patient consent; 321 patients were not enrolled; there were 116 patient refusals and 53 physician refusals; 30 patients had psychological or behavioral problems; 15 patients were missed; 92 patients had a short hospital stay; and 15 patients anticipated a change in residence. The demographic characteristics of the 321 nonenrolled and the 978 enrolled patients were similar, and the 1-year mortality of the nonenrolled and enrolled groups was 7.1% and 7.2%, respectively. Definite MIs were substantiated by the presence of any two of the following: typical coronary-type chest pain, serial acute myocardial enzyme changes, or ECG documentation (an evolving Q-wave abnormality with acute ST-segment and T-wave changes). Probable MIs had typical coronary-type chest pain with minor enzyme changes and/or acute ST-segment and T-wave changes on the ECG. recorded on prospectively designed forms as previously described.5 Clinical variables used in this study included: 1) demographic data; 2) historical comorbidity, such as prior myocardial infarction (PMI) (history of a hospital admission for documented myocardial infarction or Q-wave abnormality on the ECG of old MI), hypertension (history of elevated blood pressure necessitating treatment with specific antihypertensive medication), angina pectoris (history of recurrent precordial chest discomfort relieved by sublingual nitrates), diabetes mellitus (documented hyperglycemia necessitating treatment with antidiabetic diet, oral hypoglycemic agents, or insulin); 3) the severity of the acute coronary event in terms of LVD as manifested by pulmonary congestion and/or congestive heart failure (roentgenographic evidence of interstitial or alveolar edema, significant pulmonary rales, and/or pitting edema) in the coronary care unit; 4) ventricular irritability as determined by the presence of one or more VPDs on a predischarge 6-hour Holter recording; and 5) myocardial infarct location (MIL) as determined by the Minnesota classification'2 of a 12-lead ECG taken before discharge and categorized into anterior (Q/QS 1.11-1.12), posterior (Q/QS 1.14), and other (non-Q/QS abnormality) locations. Missing ValuesThe population used in the analyses consisted of 940 of the 978 patients in the study population. Thirtyeight patients were excluded beca...

Prognostic stratification was carried out on 518 patients less than or equal to 65 years of age who were discharged from the hospital following a definite or probable acute myocardial infarction and followed for four months. The total population was made up of 272 patients hospitalzed in 1973 and 246 patients hospitalized in 1974; one hundred and forty-two variables were collected on each patient. The clinical characteristics of the 1973 and 1974 populations were remarkably similar, and both groups had a four-month posthospital cardiac mortality rate of 4%. Two prognostic stratification schemes were developed on the 1973 population which identified low and high risk groups with meaningfully different four-month cardiac death rates. Both stratification schemes were tested on the 1974 population, and one of the two schemes was validated as identifying a significantly increased cardiac mortality rate in the high as opposed to the low risk group. The four-month posthospital cardiac mortality rate was 3% in the low and 14% in the high risk group (Z = 2.70, P less than 0.003). The high risk group was characterized by two or more of the following characteristics: 1) history of angina at ordinary levels of activity or at rest; 2) CCU hypotension and/or congestive heart failure; 3) ventricular premature beat frequency greater than or equal to 20/hr on a six-hour electrocardiographic tape recording. The low risk group had none or only one of the above characteristcis. The prognostic power of this stratification scheme is such that sixteen percent of the posthospital population can be identified as high risk, and this subgroup contains forty-six percent of the patients who die of cardiac cause in the four-month posthospital interval.