MARKERS OF RISK AFTER ACUTE MYOCARDIAL-INFARCTION - A COMPARISON OF CLINICAL-VARIABLES, AMBULATORY AND EXERCISE ELECTROCARDIOGRAPHY, ECHOCARDIOGRAPHY, AND STRESS ECHOCARDIOGRAPHY

Background Short-term mortality after myocardial infarction has decrea sed continuously among members of selected populations. Nonetheless, t he long-term prognosis among members of unselected populations remains bad. Further research in risk stratification is therefore needed. In the present study we tested the additive value of clinical variables, echocardiography, ambulatory electrocardiography, exercise testing, an d stress echocardiography in assessing the long-term prognosis after a cute myocardial infarction. Methods Two-dimensional echocardiography a nd ambulatory electrocardiography (analysis of ST-segment changes and of heart rate variability) were performed for 74 patients aged < 75 ye ars who had had an acute myocardial infarction, Before their discharge from hospital, 70 patients were subjected to a combined exercise test and stress echocardiography. The time of follow-up was greater than o r equal to 3 years. Results During follow-up 18 patients died, and 38 suffered cardiac events defined as death, nonfatal reinfarction and th e need for revascularization. We first tested 31 covariates in a univa riate regression analysis. A subsequent multivariate analysis was perf ormed in two stages. During the first of these, clinical variables (a history of systemic hypertension, infarct localization, and diabetes m ellitus) and variables derived from noninvasive tests (new-onset wall- motion abnormality during stress echocardiography, ST-segment depressi on and heart-rate variability during ambulatory electrocardiography, t he ejection fraction by echocardiography at rest, and the double produ ct during exercise tests) predicted mortality. After the second stage, however, the only remaining independent predictors of mortality were the presence of a new-onset wall-motion abnormality (P< 0.0001, relati ve risk 13.5, 95% confidence interval 3.6-51.3), ST-segment depression during ambulatory electrocardiography (P = 0.003, relative risk 5.0, 95% confidence interval 1.7-15.7) and a decreased heart rate variabili ty (P = 0.007). Conclusions The only variables that were of independen t value in assessing the long-term mortality were those expressing res idual myocardial ischemia and the cardiovascular sympatho-vagal balanc e, It is, therefore, recommended that one should monitor these variabl es for patients recovering from an acute myocardial infarction. (C) Ra pid Science Publishers.