Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1989 Dec;62(6):429–437. doi: 10.1136/hrt.62.6.429

Estimation of the risk of death during the first year after acute myocardial infarction from systolic time intervals during the first week.

B J Northover 1
PMCID: PMC1216784  PMID: 2605057

Abstract

Patients who survived for the first seven days after acute myocardial infarction were followed up for a further 51 weeks. During these 51 weeks there were 123 deaths and 477 eventual survivors. Approximately half of the deaths occurred during the first 3 weeks of follow up. The deaths were predicted with 75% sensitivity and 73% specificity by a discriminant analysis based upon six variables seen during the first 7 days; predictions of death and survival were 55% and 92% accurate respectively. These six variables were, in ascending order of prognostic importance, the occurrence of bundle branch blocks, the administration of a diuretic, the age of the patient, the presence of diabetes mellitus, a previous myocardial infarction, and the ratio of the measured left ventricular pre-ejection and ejection periods. Many other monitored variables, although univariately associated with death, contributed nothing further to the multivariate assessment of mortality risk.

Full text

PDF
429

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahnve S., Gilpin E., Henning H., Curtis G., Collins D., Ross J., Jr Limitations and advantages of the ejection fraction for defining high risk after acute myocardial infarction. Am J Cardiol. 1986 Nov 1;58(10):872–878. doi: 10.1016/s0002-9149(86)80002-9. [DOI] [PubMed] [Google Scholar]
  2. Battler A., Karliner J. S., Higgins C. B., Slutsky R., Gilpin E. A., Froelicher V. F., Ross J., Jr The initial chest x-ray in acute myocardial infarction. Prediction of early and late mortality and survival. Circulation. 1980 May;61(5):1004–1009. doi: 10.1161/01.cir.61.5.1004. [DOI] [PubMed] [Google Scholar]
  3. Battler A., Slutsky R., Karliner J., Froelicher V., Ashburn W., Ross J., Jr Left ventricular ejection fraction and first third ejection fraction early after acute myocardial infarction: value for predicting mortality and morbidity. Am J Cardiol. 1980 Feb;45(2):197–202. doi: 10.1016/0002-9149(80)90635-9. [DOI] [PubMed] [Google Scholar]
  4. Bay K. S., Lee S. J., Flathman D. P., Roll J. W., Piercy W. Application of step-wise discriminant analysis and Bayesian classification procedure in determining prognosis of acute myocardial infarction. Can Med Assoc J. 1976 Nov 6;115(9):887–892. [PMC free article] [PubMed] [Google Scholar]
  5. Bigger J. T., Jr, Fleiss J. L., Kleiger R., Miller J. P., Rolnitzky L. M. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. 1984 Feb;69(2):250–258. doi: 10.1161/01.cir.69.2.250. [DOI] [PubMed] [Google Scholar]
  6. Bigger J. T., Jr, Fleiss J. L., Rolnitzky L. M. Prevalence, characteristics and significance of ventricular tachycardia detected by 24-hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction. Am J Cardiol. 1986 Dec 1;58(13):1151–1160. doi: 10.1016/0002-9149(86)90374-7. [DOI] [PubMed] [Google Scholar]
  7. Bigger J. T., Jr, Weld F. M., Rolnitzky L. M. Prevalence, characteristics and significance of ventricular tachycardia (three or more complexes) detected with ambulatory electrocardiographic recording in the late hospital phase of acute myocardial infarction. Am J Cardiol. 1981 Nov;48(5):815–823. doi: 10.1016/0002-9149(81)90344-1. [DOI] [PubMed] [Google Scholar]
  8. Brubakk O., Pedersen T. R., Overskeid K. Noninvasive evaluation of the effect of timolol on left ventricular performance after myocardial infarction and the consequence for prognosis. J Am Coll Cardiol. 1987 Jan;9(1):155–160. doi: 10.1016/s0735-1097(87)80094-3. [DOI] [PubMed] [Google Scholar]
  9. Buckingham T. A., Thessen C. C., Stevens L. L., Redd R. M., Kennedy H. L. Effect of conduction defects on the signal-averaged electrocardiographic determination of late potentials. Am J Cardiol. 1988 Jun 1;61(15):1265–1271. doi: 10.1016/0002-9149(88)91167-8. [DOI] [PubMed] [Google Scholar]
  10. Davis H. T., DeCamilla J., Bayer L. W., Moss A. J. Survivorship patterns in the posthospital phase of myocardial infarction. Circulation. 1979 Dec;60(6):1252–1258. doi: 10.1161/01.cir.60.6.1252. [DOI] [PubMed] [Google Scholar]
  11. Dwyer E. M., Jr, Greenberg H., Case R. B. Association between transient pulmonary congestion during acute myocardial infarction and high incidence of death in six months. Am J Cardiol. 1986 Nov 1;58(10):900–905. doi: 10.1016/s0002-9149(86)80007-8. [DOI] [PubMed] [Google Scholar]
  12. Eagle K. A., Quertermous T., Singer D. E., Mulley A. G., Reder V. A., Boucher C. A., Strauss H. W., Thibault G. E. Left ventricular ejection fraction. Physician estimates compared with gated blood pool scan measurements. Arch Intern Med. 1988 Apr;148(4):882–885. [PubMed] [Google Scholar]
  13. Fioretti P., Brower R. W., Lazzeroni E., Simoons M. L., Wijns W., Reiber J. H., Bos R. J., Hugenholtz P. G. Limitations of a QRS scoring system to assess left ventricular function and prognosis at hospital discharge after myocardial infarction. Br Heart J. 1985 Mar;53(3):248–252. doi: 10.1136/hrt.53.3.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Fioretti P., Brower R. W., Simoons M. L., ten Katen H., Beelen A., Baardman T., Lubsen J., Hugenholtz P. G. Relative value of clinical variables, bicycle ergometry, rest radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring at discharge to predict 1 year survival after myocardial infarction. J Am Coll Cardiol. 1986 Jul;8(1):40–49. doi: 10.1016/s0735-1097(86)80089-4. [DOI] [PubMed] [Google Scholar]
  15. Gilpin E. A., Koziol J. A., Madsen E. B., Henning H., Ross J., Jr Periods of differing mortality distribution during the first year after acute myocardial infarction. Am J Cardiol. 1983 Aug;52(3):240–244. doi: 10.1016/0002-9149(83)90115-7. [DOI] [PubMed] [Google Scholar]
  16. Goldstein S., Friedman L., Hutchinson R., Canner P., Romhilt D., Schlant R., Sobrino R., Verter J., Wasserman A. Timing, mechanism and clinical setting of witnessed deaths in postmyocardial infarction patients. J Am Coll Cardiol. 1984 May;3(5):1111–1117. doi: 10.1016/s0735-1097(84)80167-9. [DOI] [PubMed] [Google Scholar]
  17. Gottlieb S. O., Gottlieb S. H., Achuff S. C., Baumgardner R., Mellits E. D., Weisfeldt M. L., Gerstenblith G. Silent ischemia on Holter monitoring predicts mortality in high-risk postinfarction patients. JAMA. 1988 Feb 19;259(7):1030–1035. [PubMed] [Google Scholar]
  18. Greenberg H., Gillespie J., Dwyer E. M., Jr A new electrocardiographic classification for post-myocardial infarction clinical trials. Am J Cardiol. 1987 May 1;59(12):1057–1063. doi: 10.1016/0002-9149(87)90848-4. [DOI] [PubMed] [Google Scholar]
  19. Greenberg H., McMaster P., Dwyer E. M., Jr Left ventricular dysfunction after acute myocardial infarction: results of a prospective multicenter study. J Am Coll Cardiol. 1984 Nov;4(5):867–874. doi: 10.1016/s0735-1097(84)80045-5. [DOI] [PubMed] [Google Scholar]
  20. Hakki A. H., Nestico P. F., Heo J., Unwala A. A., Iskandrian A. S. Relative prognostic value of rest thallium-201 imaging, radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring after acute myocardial infarction. J Am Coll Cardiol. 1987 Jul;10(1):25–32. doi: 10.1016/s0735-1097(87)80155-9. [DOI] [PubMed] [Google Scholar]
  21. Henning H., Gilpin E. A., Covell J. W., Swan E. A., O'Rourke R. A., Ross J., Jr Prognosis after acute myocardial infarction: a multivariate analysis of mortality and survival. Circulation. 1979 Jun;59(6):1124–1136. doi: 10.1161/01.cir.59.6.1124. [DOI] [PubMed] [Google Scholar]
  22. Hsu L., Senaratne M. P., De-Silva S., Rossall R. E., Kappagoda T. Prediction of coronary events following myocardial infarction using a discriminant function analysis. J Chronic Dis. 1986;39(7):543–552. doi: 10.1016/0021-9681(86)90199-2. [DOI] [PubMed] [Google Scholar]
  23. Killip T., 3rd, Kimball J. T. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967 Oct;20(4):457–464. doi: 10.1016/0002-9149(67)90023-9. [DOI] [PubMed] [Google Scholar]
  24. Kostis J. B., Byington R., Friedman L. M., Goldstein S., Furberg C. Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction. J Am Coll Cardiol. 1987 Aug;10(2):231–242. doi: 10.1016/s0735-1097(87)80001-3. [DOI] [PubMed] [Google Scholar]
  25. Kostis J. B., Wilson A. C., Sanders M. R., Byington R. P. Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction who receive propranolol. Am J Cardiol. 1988 May 1;61(13):975–978. doi: 10.1016/0002-9149(88)90109-9. [DOI] [PubMed] [Google Scholar]
  26. Lawrie D. M. Long-term survival after ventricular fibrillation complicating acute myocardial infarction. Lancet. 1969 Nov 22;2(7630):1085–1087. doi: 10.1016/s0140-6736(69)90697-7. [DOI] [PubMed] [Google Scholar]
  27. Madsen E. B., Gilpin E., Henning H., Ahnve S., LeWinter M., Ceretto W., Joswig W., Collins D., Pitt W., Ross J., Jr Prediction of late mortality after myocardial infarction from variables measured at different times during hospitalization. Am J Cardiol. 1984 Jan 1;53(1):47–54. doi: 10.1016/0002-9149(84)90682-9. [DOI] [PubMed] [Google Scholar]
  28. Maisel A. S., Scott N., Gilpin E., Ahnve S., Le Winter M., Henning H., Collins D., Ross J., Jr Complex ventricular arrhythmias in patients with Q wave versus non-Q wave myocardial infarction. Circulation. 1985 Nov;72(5):963–970. doi: 10.1161/01.cir.72.5.963. [DOI] [PubMed] [Google Scholar]
  29. Marcus F. I., Cobb L. A., Edwards J. E., Kuller L., Moss A. J., Bigger J. T., Jr, Fleiss J. L., Rolnitzky L., Serokman R. Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction. Am J Cardiol. 1988 Jan 1;61(1):8–15. doi: 10.1016/0002-9149(88)91295-7. [DOI] [PubMed] [Google Scholar]
  30. Mukharji J., Rude R. E., Poole W. K., Gustafson N., Thomas L. J., Jr, Strauss H. W., Jaffe A. S., Muller J. E., Roberts R., Raabe D. S., Jr Risk factors for sudden death after acute myocardial infarction: two-year follow-up. Am J Cardiol. 1984 Jul 1;54(1):31–36. doi: 10.1016/0002-9149(84)90299-6. [DOI] [PubMed] [Google Scholar]
  31. Muller J. E., Ludmer P. L., Willich S. N., Tofler G. H., Aylmer G., Klangos I., Stone P. H. Circadian variation in the frequency of sudden cardiac death. Circulation. 1987 Jan;75(1):131–138. doi: 10.1161/01.cir.75.1.131. [DOI] [PubMed] [Google Scholar]
  32. Nicod P., Gilpin E., Dittrich H., Wright M., Engler R., Rittlemeyer J., Henning H., Ross J., Jr Late clinical outcome in patients with early ventricular fibrillation after myocardial infarction. J Am Coll Cardiol. 1988 Mar;11(3):464–470. doi: 10.1016/0735-1097(88)91518-5. [DOI] [PubMed] [Google Scholar]
  33. Norris R. M., Caughey D. E., Deeming L. W., Mercer C. J., Scott P. J. Coronary prognostic index for predicting survival after recovery from acute myocardial infarction. Lancet. 1970 Sep 5;2(7671):485–487. doi: 10.1016/s0140-6736(70)90110-8. [DOI] [PubMed] [Google Scholar]
  34. Northover B. J. Left ventricular systolic time intervals in patients with acute myocardial infarction. Br Heart J. 1980 May;43(5):506–513. doi: 10.1136/hrt.43.5.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Northover B. J. The value of temporary electrical pacing for patients with acute myocardial infarction. Methods Inf Med. 1984 Jan;23(1):23–28. [PubMed] [Google Scholar]
  36. Northover B. J. Ventricular tachycardia during the first 72 hours after acute myocardial infarction. Cardiology. 1982;69(3):149–156. doi: 10.1159/000173497. [DOI] [PubMed] [Google Scholar]
  37. Olson H. G., Lyons K. P., Troop P., Butman S. M., Piters K. M. Prognostic implications of complicated ventricular arrhythmias early after hospital discharge in acute myocardial infarction: a serial ambulatory electrocardiography study. Am Heart J. 1984 Nov;108(5):1221–1228. doi: 10.1016/0002-8703(84)90745-2. [DOI] [PubMed] [Google Scholar]
  38. Rapaport E., Remedios P. The high risk patient after recovery from myocardial infarction: recognition and management. J Am Coll Cardiol. 1983 Feb;1(2 Pt 1):391–400. doi: 10.1016/s0735-1097(83)80065-5. [DOI] [PubMed] [Google Scholar]
  39. Schelbert H. R., Henning H., Ashburn W. L., Verba J. W., Karliner J. S., O'Rourke R. A. Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarction. Am J Cardiol. 1976 Oct;38(4):407–415. doi: 10.1016/0002-9149(76)90455-0. [DOI] [PubMed] [Google Scholar]
  40. Schulman S. P., Achuff S. C., Griffith L. S., Humphries J. O., Taylor G. J., Mellits E. D., Kennedy M., Baumgartner R., Weisfeldt M. L., Baughman K. L. Prognostic cardiac catheterization variables in survivors of acute myocardial infarction: a five year prospective study. J Am Coll Cardiol. 1988 Jun;11(6):1164–1172. doi: 10.1016/0735-1097(88)90277-x. [DOI] [PubMed] [Google Scholar]
  41. Schulze R. A., Jr, Strauss H. W., Pitt B. Sudden death in the year following myocardial infarction. Relation to ventricular premature contractions in the late hospitals phase and left ventricular ejection fraction. Am J Med. 1977 Feb;62(2):192–199. doi: 10.1016/0002-9343(77)90314-x. [DOI] [PubMed] [Google Scholar]
  42. Schwartz H., Leiboff R. L., Katz R. J., Wasserman A. G., Bren G. B., Varghese P. J., Ross A. M. Arteriographic predictors of spontaneous improvement in left ventricular function after myocardial infarction. Circulation. 1985 Mar;71(3):466–472. doi: 10.1161/01.cir.71.3.466. [DOI] [PubMed] [Google Scholar]
  43. Simson M. B. Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation. 1981 Aug;64(2):235–242. doi: 10.1161/01.cir.64.2.235. [DOI] [PubMed] [Google Scholar]
  44. Smith J. W., Marcus F. I., Serokman R. Prognosis of patients with diabetes mellitus after acute myocardial infarction. Am J Cardiol. 1984 Oct 1;54(7):718–721. doi: 10.1016/s0002-9149(84)80196-4. [DOI] [PubMed] [Google Scholar]
  45. Sniderman A. D., Beaudry J. P., Rahal D. P. Early recognition of the patient at late high risk: incomplete infarction and vulnerable myocardium. Am J Cardiol. 1983 Oct 1;52(7):669–673. doi: 10.1016/0002-9149(83)90395-8. [DOI] [PubMed] [Google Scholar]
  46. Stewart D. E., Ikram H., Espiner E. A., Nicholls M. G. Arrhythmogenic potential of diuretic induced hypokalaemia in patients with mild hypertension and ischaemic heart disease. Br Heart J. 1985 Sep;54(3):290–297. doi: 10.1136/hrt.54.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Surawicz B. Prognosis of ventricular arrhythmias in relation to sudden cardiac death: therapeutic implications. J Am Coll Cardiol. 1987 Aug;10(2):435–447. doi: 10.1016/s0735-1097(87)80030-x. [DOI] [PubMed] [Google Scholar]
  48. Taylor G. J., Humphries J. O., Mellits E. D., Pitt B., Schulze R. A., Griffith L. S., Achuff S. C. Predictors of clinical course, coronary anatomy and left ventricular function after recovery from acute myocardial infarction. Circulation. 1980 Nov;62(5):960–970. doi: 10.1161/01.cir.62.5.960. [DOI] [PubMed] [Google Scholar]
  49. Tibbits P. A., Evaul J. E., Goldstein R. E., Boccuzzi S. J., Therneau T. M., Parker R., Wong D. Serial acquisition of data to predict one-year mortality rate after acute myocardial infarction. Am J Cardiol. 1987 Sep 1;60(7):451–455. doi: 10.1016/0002-9149(87)90284-0. [DOI] [PubMed] [Google Scholar]
  50. Tofler G. H., Stone P. H., Muller J. E., Rutherford J. D., Willich S. N., Gustafson N. F., Poole W. K., Sobel B. E., Willerson J. T., Robertson T. Prognosis after cardiac arrest due to ventricular tachycardia or ventricular fibrillation associated with acute myocardial infarction (the MILIS Study). Multicenter Investigation of the Limitation of Infarct Size. Am J Cardiol. 1987 Oct 1;60(10):755–761. doi: 10.1016/0002-9149(87)91018-6. [DOI] [PubMed] [Google Scholar]
  51. Warnowicz M. A., Parker H., Cheitlin M. D. Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction. Circulation. 1983 Feb;67(2):330–334. doi: 10.1161/01.cir.67.2.330. [DOI] [PubMed] [Google Scholar]
  52. Weissler A. M., O'Neill W. W., Sohn Y. H., Stack R. S., Chew P. C., Reed A. H. Prognostic significance of systolic time intervals after recovery from myocardial infarction. Am J Cardiol. 1981 Dec;48(6):995–1002. doi: 10.1016/0002-9149(81)90311-8. [DOI] [PubMed] [Google Scholar]
  53. Weissler A. M. The systolic time intervals and risk stratification after acute myocardial infarction. J Am Coll Cardiol. 1987 Jan;9(1):161–162. doi: 10.1016/s0735-1097(87)80095-5. [DOI] [PubMed] [Google Scholar]
  54. Willems J. L., Robles de Medina E. O., Bernard R., Coumel P., Fisch C., Krikler D., Mazur N. A., Meijler F. L., Mogensen L., Moret P. Criteria for intraventricular conduction disturbances and pre-excitation. World Health Organizational/International Society and Federation for Cardiology Task Force Ad Hoc. J Am Coll Cardiol. 1985 Jun;5(6):1261–1275. doi: 10.1016/s0735-1097(85)80335-1. [DOI] [PubMed] [Google Scholar]
  55. Winkle R. A., Peters F., Hall R. Characterization of ventricular tachyarrhythmias on ambulatory ECG recordings in post-myocardial infarction patients: arrhythmia detection and duration of recording, relationship between arrhythmia frequency and complexity, and day-to-day reproducibility. Am Heart J. 1981 Aug;102(2):162–169. doi: 10.1016/s0002-8703(81)80004-x. [DOI] [PubMed] [Google Scholar]
  56. Wolffenbuttel B. H., Verdouw P. D., Scheffer M. G., Bom H. P., Bijleveld R. E., Hugenholtz P. G. Significance of haemodynamic variables in coronary care unit for prediction of survival after acute myocardial infarction. Br Heart J. 1983 Sep;50(3):266–272. doi: 10.1136/hrt.50.3.266. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. van der Laarse A., Kerkhof P. L., Vermeer F., Serruys P. W., Hermens W. T., Verheugt F. W., Bär F. W., Krauss X. H., van der Wall E. E., Simoons M. L. Relation between infarct size and left ventricular performance assessed in patients with first acute myocardial infarction randomized to intracoronary thrombolytic therapy or to conventional treatment. Am J Cardiol. 1988 Jan 1;61(1):1–7. doi: 10.1016/0002-9149(88)91294-5. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES