This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Andresen, D. Articles by Ehlers, H.-C. Search for Related Content PubMed PubMed Citation Articles by Andresen, D. Articles by Ehlers, H.-C.

CLINICAL STUDIES

Risk stratification following myocardial infarction in the thrombolytic era

a two-step strategy using noninvasive and invasive methods

Dietrich Andresen, MD, FACC^a, Gerhard Steinbeck, MD^*, Thomas Brüggemann, MSc^a, Dirk Müller, MD, Ralph Haberl, MD^*, Steffen Behrens, MD, Ellen Hoffmann, MD^*, Karl Wegscheider, PhD, R.üdiger Dissmann, MD and Hans-Christoph Ehlers, MD^a

^a Medizinische Klinik I, Urban-Krankenhaus, Berlin, Germany
^* Medizinische Klinik I, Klinikum Grosshadern, Ludwig Maximilians Universität, München, Germany
Medizinische Klinik II, Klinikum Benjamin Franklin, Freie Universität, Berlin, Germany
Institute for Econometry and Statistics, University of Hamburg, Hamburg, Germany
Zentralkrankenhaus Reinkenheide, Bremerhaven, Germany

Manuscript received March 26, 1998; revised manuscript received July 21, 1998, accepted September 15, 1998.

Address for correspondence: Prof. Dr. Dietrich Andresen, Urban-Krankenhaus, Medizinische Klinik I, Dieffenbachstrasse 1, 10967 Berlin, Germany
andresen{at}zedat.fu-berlin.de

Objectives. We prospectively performed a two-step risk assessment in patients in the early phase after acute myocardial infarction (MI).

Background. Noninvasive methods like Holter electrocardiographic monitoring (HM) and determination of the left ventricular ejection fraction (EF) as well as the invasive technique of programmed ventricular stimulation (PVS) have been used to identify patients in the late phase after MI as candidates for prophylactic implantation of a cardioverter/defibrillator. However, it is unclear whether these results can be transferred to patients following acute MI.

Methods. A series of 657 patients with acute MI (75 years) underwent HM and EF. If one of the two methods yielded abnormal findings (HM 20 ventricular ectopic beats/h/10 ventricular pairs/day/ventricular tachycardia; EF 40%), PVS was done (abnormal PVS: induction of monomorphic ventricular tachycardia, duration >10 s, cycle length 230 ms).

Results. Of 657 patients, 304 (46%) had either an abnormal HM or EF. The PVS performed in 146 of 304 patients was abnormal in 22. During a mean follow-up of 37 months, there were 106 (16%) deaths, being sudden in 24 (3.6%), nonsudden cardiac in 45 (6.8%). The incidence of arrhythmic events (sudden cardiac death, symptomatic ventricular tachycardia, cardiac arrest) was 18% (4/22) with an abnormal PVS and only 4% (5/124) with a normal PVS (odds ratio 4.0, p = 0.032).

Conclusions. The rate of arrhythmic events is low in post-MI patients in the 1990s. Nevertheless, a two-step risk stratification is helpful in selecting candidates for a defibrillator trial aiming at primary prevention of sudden cardiac death after MI.

Abbreviations and Acronyms   EF = left ventricular ejection fraction   HM = 24-h Holter electrocardiographic (ECG) monitoring   MI = myocardial infarction   PVS = programmed ventricular stimulation   RNV = radionuclide ventriculography   SCD = sudden cardiac death   VEB = ventricular ectopic beats   VC = ventricular couplets   VT = ventricular tachycardia

This article has been cited by other articles:

				G. Steinbeck, D. Andresen, K. Seidl, J. Brachmann, E. Hoffmann, D. Wojciechowski, Z. Kornacewicz-Jach, B. Sredniawa, G. Lupkovics, F. Hofgartner, et al. Defibrillator Implantation Early after Myocardial Infarction N. Engl. J. Med., October 8, 2009; 361(15): 1427 - 1436. [Abstract] [Full Text] [PDF]

				J. J. Bailey, M. Hodges, and T. R. Church Decision to Implant a Cardioverter Defibrillator after Myocardial Infarction: The Role of Ejection Fraction v. Other Risk Factor Markers Med Decis Making, March 1, 2007; 27(2): 151 - 160. [Abstract] [PDF]

				D. E. Hofsten, K. Wachtell, B. Lund, H. Molgaard, K. Egstrup, and on behalf of the DANAMI-2 Investigators Prevalence and prognostic implications of non-sustained ventricular tachycardia in ST-segment elevation myocardial infarction after revascularization with either fibrinolysis or primary angioplasty Eur. Heart J., February 2, 2007; 28(4): 407 - 414. [Abstract] [Full Text] [PDF]

				A. Raviele, M. G. Bongiorni, M. Brignole, R. Cappato, A. Capucci, F. Gaita, M. Gulizia, S. Mangiameli, A. S. Montenero, R. F. E. Pedretti, et al. Early EPS/ICD strategy in survivors of acute myocardial infarction with severe left ventricular dysfunction on optimal beta-blocker treatment: The BEta-blocker STrategy plus ICD trial Europace, January 1, 2005; 7(4): 327 - 337. [Abstract] [Full Text] [PDF]

				G. Steinbeck, D. Andresen, J. Senges, E. Hoffmann, K. Seidl, J. Brachmann, and for the IRIS investigators as Joint Study of the G Immediate Risk-Stratification Improves Survival (IRIS): study protocol Europace, January 1, 2004; 6(5): 392 - 399. [Abstract] [Full Text] [PDF]

				H. V. Huikuri, T. H. Makikallio, M. J. P. Raatikainen, J. Perkiomaki, A. Castellanos, and R. J. Myerburg Prediction of Sudden Cardiac Death: Appraisal of the Studies and Methods Assessing the Risk of Sudden Arrhythmic Death Circulation, July 8, 2003; 108(1): 110 - 115. [Full Text] [PDF]

				K. Soejima and W. G. Stevenson Ventricular Tachycardia Associated With Myocardial Infarct Scar: A Spectrum of Therapies for a Single Patient Circulation, July 9, 2002; 106(2): 176 - 179. [Full Text] [PDF]

				T. H. Makikallio, H. V. Huikuri, M. T. La Rovere, G. D. Pinna, S. H. Hohnloser, F. I. Marcus, A. Mortara, R. Nohara, J. T. Bigger Jr, A. J. Camm, et al. Risks in Risk Stratification: What Is Relevant in Practice? * Response Circulation, March 26, 2002; 105 (12): e69 - e70. [Full Text] [PDF]

				S. G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, J. A. Camm, R. Cappato, S. M. Cobbe, C. Di Mario, et al. TASK FORCE ON SUDDEN CARDIAC DEATH, EUROPEAN SOCIETY OF CARDIOLOGY: Summary of Recommendations Europace, January 1, 2002; 4(1): 3 - 18. [Abstract] [PDF]

				S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]

				D.H. Birnie and S.M. Cobbe Risk of sudden death after discharge following myocardial infarction Eur. Heart J., July 2, 2001; 22(14): 1153 - 1155. [PDF]

				L Jordaens, R Tavernier, and MIRRACLE Investigators Determinants of sudden death after discharge from hospital for myocardial infarction in the thrombolytic era Eur. Heart J., July 2, 2001; 22(14): 1214 - 1225. [Abstract] [PDF]

				C. Schmitt, P. Barthel, G. Ndrepepa, J.u. Schreieck, A. Plewan, A. Schomig, and G. Schmidt Value of programmed ventricular stimulation for prophylactic internal cardioverter-defibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1901 - 1907. [Abstract] [Full Text] [PDF]

				H. V. Huikuri, T. Makikallio, K. E. J. Airaksinen, R. Mitrani, A. Castellanos, and R. J. Myerburg Measurement of heart rate variability: a clinical tool or a research toy? J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1878 - 1883. [Abstract] [Full Text] [PDF]

				C. de Chillou, D. Lacroix, D. Klug, I. Magnin-Poull, C. Marquie, M. Messier, M. Andronache, C. Kouakam, N. Sadoul, J. Chen, et al. Isthmus Characteristics of Reentrant Ventricular Tachycardia After Myocardial Infarction Circulation, February 12, 2002; 105(6): 726 - 731. [Abstract] [Full Text] [PDF]