Ap. Schroeder et al., Clinical assessment of indication for ACE-inhibitor treatment early after acute myocardial infarction, SC CARDIOVA, 33(3), 1999, pp. 137-142
An investigation was conducted to assess whether an algorithm based on simp
le clinical information would suffice to classify patients with acute myoca
rdial infarction, with respect to indication for angiotensin-converting-enz
yme inhibitor treatment. One hundred consecutive patients with myocardial i
nfarction were prospectively studied. Based on clinical, radiological, elec
trocardiographic and biochemical information, the patients were classified
as having (a) significantly depressed left ventricular function (ejection f
raction less than or equal to 40%) justifying treatment with angiotensin-co
nverting-enzyme inhibitors (ACEI), (b) preserved ventricular function (ejec
tion fraction >40%) making ACEI unnecessary, or (c) indeterminate ventricul
ar function, requiring further examination. Using a blinded design, ejectio
n fraction was determined by echocardiography and radionuclide ventriculogr
aphy. A clinical assumption of reduced left ventricular function had a pred
ictive value of an echocardiographically determined ejection fraction less
than or equal to 40% of 83% (n = 23). Clinical criteria of good ventricular
function had a predictive value of ejection fraction >40% of 96% (n = 24).
In these two groups clinical misclassification occurred in five patients w
ith ejection fraction within the range of 39-45%. Left ventricular function
was found to be clinically indeterminate in 53 of the 100 patients. Ejecti
on fraction values assessed by radionuclide ventriculography (n = 44) were
on average 9.3%-points lower than echocardiographic values. The indication
for ACEI can apparently be determined on the basis of readily available cli
nical information in approximately 50% of patients with acute myocardial in
farction.