Long-term prognostic importance of hyperkinesia following acute myocardialinfarction

The long-term prognostic importance of hyperkinesia is unknown following an acute myocardial infarction (AMI). The American Society of Echocardiograph y recommends that hyperkinesia should not be included in calculation of wal l motion index (WMI). The objective of the present study was to determine i f hyperkinesia should be included in WMI when it is estimated for prognosti c purposes following an AMI. Six thousand, six hundred seventy-six consecut ive patients were screened 1 to 6 after AMI in 27 Danish hospitals. WMI was In 6,232 patients applying the 9-segment model and the following scoring s ystem: 3 for hyperkinesia, 2 for normokinesia, 1 for hypokinesia, 0 for aki nesia, and -1 for dyskinesia. All patients were followed with respect to mo rtality for at least 3 years. WMI was calculated in 2 different ways: 1 inc luding hyperkinetic segments (hyperkinetic-WMI) and the other excluding non hyperkinetic segments (nonhyperkinetic-WMI) by converting the hyperkinetic segments to normokinetic segments. Hyperkinesia occurred in 736 patients ( 11.8 %). WMI was an important prognostic factor (relative risk 2.49; p = 0. 0001) for long-term mortality together with heart failure, history of hyper tension, angina, or diabetes, previous AMI, age, thrombolytic therapy, arrh ythmias, and bundle branch block. In a multivariate analysis including nonh yperkinetic-WMI, hyperkinesia was associated with a relative risk of 0.84, which was statistically significant (confidence intervals 0.74 to 0.96; p = 0.01). When hyperkinesia was included, both in WMI (hyperkinetic-WMI) and as an independent variable, no additional prognostic information (relative risk 0.93; p = 0.26) was obtained. An echocardiographic evaluation shortly after an AMI gave important prognostic information, especially if the infor mation concerning hyperkinesia was included. If WMI is used for prognostic purposes, hyperkinesia should be included in calculation of the index. (C)1 999 by Excerpta Medica, Inc.