[The "arrhythmic pattern": a new method with prognostic significance in myocardial infarct].
OBJECTIVE
To establish a score or arrhythmic pattern for the prediction of long-term cardiac deaths on patients who have survived to the first acute myocardial infarction.


METHODS
We studied prospectively 200 patients that survived at a first myocardial infarction and in whom ambulatory ECG monitoring during 24 hours between days 7th and 18th (mean 12th) from the infarction was performed. The mean follow-up time was 51 +/- 18 months. The number and type of ventricular arrhythmias were analyzed and a score was measured, accordingly with Castellanos and Lown's classifications. An "arrhythmic pattern" or "total punctuation" was defined and compared among two groups: group 1 > 65 points and group 2 < 65 points.


RESULTS
The differential characteristics of both groups were: age (60 +/- 9 versus 56 +/- 10 years old; p = 0.004); hypertension (63% versus 29%; p < 0.001); clinic stage II-III (23% versus 11%; p = 0.02); echocardiographic ejection fraction (45 +/- 11% versus 50 +/- 10%; p = 0.04); positive exercise testing (73% versus 56%; p = 0.01); arrhythmias on the exercise test (15% versus 25%; p = 0.006). The long-term cardiac mortality was 25% versus 6% (p = 0.01), with an incidence of sudden death of 11% versus 3% (p < 0.05). Specificity, sensibility, positive predictive value and negative predictive value (reference cut point of 100) were 94, 65, 71 and 91%, respectively.


CONCLUSIONS
The use of a score of arrhythmic pattern may identify 2 groups of patients with different clinic profiles that probably justify a different long-term prognosis after a first acute myocardial infarction.
Arribas
A
A
Servicio de Cardiología, Hospital Clínico, Salamanca.
Martín Luengo
C
C
Rodríguez
J
J
Pabón
P
P
Nieto
F
F
Diego
M
M
Castaño
L
L
Santos
I
I
Cascón
M
M
Sala
A
A
D005117:Cardiac Complexes, Premature / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory / Q000379:methods / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D013997:Time Factors