Independent prognostic risk factors for patients referred because of suspected acute myocardial infarction without
J K Madsen1, B L Thomsen, K Mellemgaard
1Medical Department B, Frederiksborg County Central Hospital, Hillerød Denmark.
European Heart Journal
|June 1, 1988
Summary
Patients suspected of acute myocardial infarction (AMI) but not confirmed still face cardiac event risks. An electrocardiogram (ECG) at rest and during exercise can identify high-risk individuals needing close monitoring.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Testing
Background:
- Patients referred to coronary care units for suspected acute myocardial infarction (AMI) but not confirmed represent a population at risk.
- Cardiac events, including AMI or cardiac death, can occur post-discharge in this patient group.
- Understanding prognostic variables is crucial for risk stratification and patient management.
Purpose of the Study:
- To identify variables associated with the risk of cardiac events after discharge in patients with initially unconfirmed AMI.
- To determine the independent prognostic value of various clinical and diagnostic parameters.
- To guide risk assessment and follow-up strategies for these patients.
Main Methods:
- Prospective follow-up of 257 patients under 76 years old for 12-24 months (median 14 months).
- Analysis of medical history, resting and exercise electrocardiograms (ECG), thallium scintigraphy, chest X-ray, echocardiography, systolic time intervals, and Holter monitoring.
- Multivariate analysis to identify independent predictors of cardiac events.
Main Results:
- The estimated percentage of patients without a cardiac event after one year was 91.3%.
- Combined resting and exercise ECG findings were the sole independent predictor of cardiac events.
- Abnormalities in resting ECG (ST deviation, Q-wave, negative T-wave, intraventricular block) or exercise ECG response increased cardiac event hazard by a factor of 11.8.
Conclusions:
- Patients with initially unconfirmed AMI are at significant risk of future cardiac events.
- Exercise testing is recommended for risk stratification in this population.
- Close follow-up is warranted for patients exhibiting abnormal resting and/or exercise ECG findings.
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