Open infarct artery, late potentials, and other prognostic factors in patients after acute myocardial infarction in the thrombolytic era. A prospective trial.

Abstract

In patients with acute myocardial infarction treated according to contemporary therapeutic guidelines, with a large proportion of individuals undergoing coronary artery revascularization, a low incidence of arrhythmic events, particularly of ventricular tachycardia, was observed in the first year after the index infarction. The presence or absence of an open infarct-related artery was the strongest independent predictor of these events, whereas other traditional risk factors, such as late potentials, were less helpful in identifying patients prone to sudden death. These findings emphasize the importance of the open artery hypothesis in patients recovering from acute myocardial infarction.

Arrhythmogenic cardiomyopathy of the right ventricle. Predictive value of QT interval dispersion to assess arrhythmogenic risk and sudden death

“…The method did not differentiate patients with and without the terminal sudden event. It showed a very low predictive value (25%) similar to the one observed with the isolated use of other methods, such as extrasystoles on Holter monitoring 33 or signal-averaged electrocardiography 34 . With this method, patients with arrhythmogenic right ventricular cardiomyopathy showed an increase in the degree of QTDp as compared with healthy individuals.…”

Long-Term Outcome of Percutaneous Coronary Intervention of a Persistent Total Occlusion in the Infarct-Related Coronary Artery

“…There are several possible mechanisms of benefit from late PCI outside the time window of myocardial salvage. These may include reduction of ventricular remodeling, decreased ventricular instability with the resulting diminished incidence of ventricular arrhythmias, and provision of collateral vessels to other territories in the event of further coronary artery occlusion [5][6][7][8][9][10]. In addition to promoting an acute inflammatory response and local edema, reperfusion of IRA with an adequate blood flow at a proper arterial perfusion pressure increases tissue turgor, which may have a scaffolding further reinforced by other reported studies [21][22][23][24][25].…”

Role of noninvasive studies in risk stratification for sudden cardiac death

“…The original prospective studies of the prognostic significance of the SA-ECG after MI were done in the prethrombolytic era, although subsequent studies in patients largely treated with thrombolytic therapy or angioplasty have continued to demonstrate that the SAECG is strongly associated with an increased risk of spontaneous arrhythmic events, with a positive predictive accuracy ranging from 11 to 25%. [21][22][23][24][25] A recent study of 575 patients after MI compared the predictive accuracy of four major risk predictors-the SAECG, LVEF, ventricular arrhythmias in a 24-h Holter recording, and heart rate variability. 26 While all of the variables were univariate predictors of cardiac death and arrhythmic death, in multivariate analysis only decreased heart rate variability and unsustained VT were independently associated with arrhythmic death; the SAECG did not provide independent prognostic information beyond that accounted for by these other three variables.…”