Predictors of early death after acute myocardial infarction: two months follow-up

Abstract

Clinical variables and the results of non-invasive tests (exercise test, echocardiogram, gated equilibrium radionuclide ventriculography and 24 h ECG) were recorded in a series of 202 patients who left the hospital alive after an acute myocardial infarction. The short term (two months) predictive value of all these data was prospectively assessed by uni- and multi-variate analysis. The best correlation with early death was observed with the variables related to the extent of infarction and left ventricular dysfunction, namely: early clinical signs of heart failure, high peak CK-MB level, complete bundle branch block, increased cardiothoracic ratio on chest X-Ray, number of Mets reached during the stress test, echocardiographic dyskinesia index, and decreased left ventricular ejection fraction as measured by radionuclide ventriculography. Using multi-variate stepwise discriminant analysis, the following independent prognostic factors appeared by order of entry: early clinical signs of heart failure, peak CK-MB level and cardiothoracic ratio on chest X-Ray. These results highlight the short-term predictive value of the data related to left ventricular dysfunction and especially of simple clinical data for patients surviving an acute myocardial infarction.

Left Ventricular Ejection Fraction Assessment Among Patients With Acute Myocardial Infarction and Its Association With Hospital Quality of Care and Evidence-Based Therapy Use

“…Clinical practice guidelines have incorporated the assessment of LVEF as a core performance measure for patients with STEMI and NSTEMI, 1 because LVEF has both prognostic and therapeutic significance for these patients. Left ventricular systolic dysfunction after AMI predicts long term-mortality, 4 and a reduced LVEF may prompt greater consideration of invasive treatment. Furthermore, the optimization of post-MI medical therapies are predicated, in part, on left ventricular systolic function; 1 thus, knowledge of LVEF during the index MI hospitalization is needed to guide care strategy.…”

“…1,2 Reduced LVEF is associated with greater mortality among patients with coronary artery disease 3 and predicts increased risks of early all-cause mortality, 4 as well as sudden cardiac death 5 after AMI. Improvement of LVEF with revascularization is associated with improved long-term survival among AMI patients.…”

Worsening of heart failure during hospital course of an unselected cohort of 2507 patients with myocardial infarction is a factor of poor prognosis: the PRIMA study

“…Worsening of HF occurred less often in patients with Killip class I at admission compared to those with Killip class >I (although this was not so in univariate analysis; univariate analyses should always be completed with multivariate analyses). In a study in 202 patients, HF at admission was present in 16% of the surviving patients and in 91% of the deceased patients, whereas HF after the third day was present in 6% of the surviving patients and in 36% of the deceased patients [26]. Thrombolysis was not predictive of HF at admission, or of its worsening.…”

Relative power of clinical, exercise test, and angiographic variables in predicting clinical outcome after myocardial infarction: the Newham and Tower Hamlets study.

“…A positive exercise test was defined as the development of (a) angina pectoris; (b) horizontal or downsloping ST depression > 1 mm, 80 ms after the J point; (c) an inappropriate blood pressure response defined as failure of the systolic blood pressure to rise 10 mm Hg or more, or, having risen, to fall again by 10 mm Hg or more (the latter finding had to be confirmed immediately the patient stopped exercising); (d) inability to complete the exercise test because of severe dyspnoea, fatigue, or ataxia; (e) increase in the frequency of ventricular extrasystoles of >6 greater than the count on the pre-exercise 379 electrocardiogram or development of ventricular triplets. GROUP UNDERGOING CARDIAC CATHETERISATION (GROUP 3) Cardiac catheterisation was performed at a median of 21 (interquartile range, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] days after infarction in patients with a positive exercise test. One hundred and thirty nine patients (53% of group 2) were defined as having a positive exercise test but 16 of these patients did not undergo catheterisation for the following reasons: (a) four died before cardiac catheterisation; (b) five refused cardiac catheterisation; (c) four had exercise tests erroneously reported as "negative" (in each case an inappropriate blood pressure response had been overlooked) and were not therefore put forward for catheterisation; (d) three because of administrative error.…”