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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

View larger version (21K): [in a new window]   Figure 1 Clinical outcome among 657 myocardial infarction patients during 37 ± 17 months’ follow-up according to risk assessment by noninvasive methods and programmed ventricular stimulation. EF = left ventricular ejection fraction; MI = myocardial infarction; HM = Holter ECG monitoring; PVS = programmed ventricular stimulation; non-SCD = non-sudden cardiac death. p Values derived from Cox regression analysis.

View larger version (15K): [in a new window]   Figure 2 Arrhythmic event-free survival (absence of sudden arrhythmic death, symptomatic ventricular tachycardia, or cardiac arrest) according to the stepwise risk stratification protocol using noninvasive methods (upper panel) and programmed ventricular stimulation (lower panel). PVS was only performed in patients with abnormal HM or EF. HM = Holter ECG monitoring; PVS = programmed ventricular stimulation; EF = left ventricular ejection fraction. p Values derived from Cox regression analysis.

View larger version (16K): [in a new window]   Figure 3 Survival analysis of non-sudden cardiac death according to the stepwise risk stratification protocol using noninvasive methods (upper panel) and programmed ventricular stimulation (lower panel). PVS was only performed in patients with abnormal HM or EF. HM = Holter ECG monitoring; PVS = programmed ventricular stimulation; EF = left ventricular ejection fraction. p Values derived from Cox regression analysis.