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Risk stratification and survival in post myocardial infarction patients: a large prospective and multicenter study in
Jun Ohno1, Eiichi Watanabe, Junji Toyama
1Department of Cardiology, Higashi Municipal Hospital of Nagoya, Nagoya, Japan.
Insights
Identifying high-risk patients after myocardial infarction (MI) is crucial. Age over 70, heart failure, left ventricular dysfunction, and lack of acute-reperfusion therapy predict mortality in post-MI patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Implantable cardioverter-defibrillator (ICD) use can reduce mortality in high-risk ischemic heart disease patients.
- Identifying patients susceptible to sudden arrhythmic death after myocardial infarction (MI) is essential due to the high cost and invasiveness of ICDs.
Purpose of the Study:
- To assess clinical predictors of mortality in post-MI patients in Japan.
Main Methods:
- Analysis of 495 consecutive MI survivors.
- 24-h ambulatory ECGs for nonsustained ventricular tachycardia (NSVT) detection.
- Assessment of left ventricular ejection fraction (LVEF) and heart failure (Killip scale).
- Kaplan-Meier survival analysis and multivariate Cox regression.
Main Results:
- Mortality rates were higher in patients aged ≥70, with heart failure, without acute-reperfusion therapy, or with LVEF ≤35%.
- Nonsustained ventricular tachycardia (NSVT) predicted death only in patients without acute-reperfusion.
- Age ≥70 was an independent predictor of total mortality (OR, 1.06; 95% CI, 1.01-1.11).
Conclusions:
- High-risk post-MI patients can be identified using age, ventricular dysfunction, heart failure, and acute-reperfusion status.
- NSVT has prognostic value primarily in post-MI patients not receiving acute-reperfusion therapy.
Background:
Recent clinical trials suggest that the mortality in high-risk patients with ischemic heart disease can be significantly reduced with the use of implantable cardioverter-defibrillator (ICD). Given the high cost and invasiveness of the procedure, it is important to apply it to the patients after myocardial infarction (MI) highly susceptible to sudden arrhythmic death.
Objective:
The purpose of this study was to assess clinical predictors of mortality in post-MI patients in Japan.
Methods And Results:
In 495 consecutive MI survivors, 350 (71%) received acute-reperfusion therapy, whereas 145 (29%) did not. Nonsustained ventricular tachycardia (NSVT) was present in 136 patients (28%) in 24-h ambulatory ECGs at 7+/-6 in-hospital days. Left ventricular dysfunction (LVEF< or =35%) was present in 20/347 patients (5.7%) at 13+/-8 days. Forty-eight patients (9.7%) died during the follow-up period (48+/-13 months); 23 from cardiac and 25 from noncardiac causes. Kaplan-Meier survival analyses showed that mortality rates were higher among patients who were > or =70 years old (log-rank test, P<0.0001); had heart failure at admission (Killip scale> or =2, P=0.001); did not receive acute-reperfusion (P=0.004); and had left ventricular dysfunction with LVEF< or =35% (P=0.02). The presence of NSVT was a significant predictor of death (P=0.036) only in the patients who did not receive acute-reperfusion. Multivariate Cox regression analysis revealed that an independent predictor of total mortality was an age> or =70 (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P<0.00001).
Conclusions:
High-risk patients after acute MI can be identified on the basis of age, ventricular dysfunction, heart failure and acute-reperfusion therapy. The presence of NSVT before discharge has a prognostic value only in the patients without acute-reperfusion.
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