Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy

Citation
M. Jensen-urstad et al., Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy, J INTERN M, 249(6), 2001, pp. 527-537
Citations number
33
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
JOURNAL OF INTERNAL MEDICINE
ISSN journal
0954-6820 → ACNP
Volume
249
Issue
6
Year of publication
2001
Pages
527 - 537
Database
ISI
SICI code
0954-6820(200106)249:6<527:RAIPWA>2.0.ZU;2-V
Abstract
Objective. Several noninvasive methods have prognostic information regardin g mortality and new coronary events after an acute myocardial infarction (A MI). The practical for clinical decision-malting in the immediate postmyoca rdial infarction (MI) period is, however, less evident. We investigated con secutive patients with AMI treated with thrombolysis to further clarify thi s issue. Design. A total of 100 patients (27% women) aged 64 +/- 9 years (mean +/- S D) were studied. Risk assessment based on a clinical score system, myocardi al perfusion scintigraphy single photon emission computed tomography (SPECT ) at rest and during adenosine stress, echocardiography, radionuclide angio graphy, symptom-limited exercise stress test, and 24-h Holter ECG recording with ST-analysis and analysis of heart rate variability (HRV) were perform ed 5-8 days after hospital admission. Mortality, nonfatal reinfarction, and the need for revascularization were followed during 12 months. Setting. A university hospital. Results, A total of 6 patients died, seven had a nonfatal reinfarction, and 23 were revascularized. inability to perform an exercise lest (P = 0.004) and an ejection fraction (EF) <40% (P = 0.002) were the only parameters sep arating those who died from the survivors. No method could predict a nonfat al reinfarction. Patients suffering either death or nonfatal reinfarction h ad a clinical risk assessment score 2 points higher (8.8 vs. 6.7, P = 0.05) than the group without such events. A positive symptom-limited exercise st ress test (P = 0.027), ST-depressions on Holter ECG (P = 0.04), and reversi bility on myocardial perfusion scintigraphy (P = 0.029) predicted the need for revascularization. Conclusion. Risk assessment based on clinical information, exercise stress testing, and an estimate of left ventricular function (e.g. via echocardiog raphy) contribute with prognostic information in thrombolysed MI-patients. Additional noninvasive investigations such as adenosine-SPECT, analysis of HRV, and Holter-monitoring do not add to these commonly available tools in risk stratification of subjects at low to medium risk.