title: Continuous electrocardiographic monitoring for more than one hour does not improve the prognostic value of ventricular arrhythmias in survivors of first acute myocardial infarction.
abstract: This study was designed to compare the prognostic value of predischarge ambulatory electrocardiographic monitoring for 1, 6 and 24 hours in 188 patients surviving a first acute myocardial infarction. Ventricular premature complexes (VPCs) were considered as a mean hourly rate or classified using Lown and Moss grading systems. During the 1-year follow-up 20 cardiac deaths occurred. For all 3 monitoring times, a higher number of VPCs/hour and a higher Moss grade were associated with mortality, whereas a Lown grading system gave prognostic information only for the first hour of recording. Monitoring time did not influence specificity or sensitivity in predicting mortality; > or = 3 VPCs/hour showed a higher sensitivity than > or = 10 VPCs/hour (p < 0.05) with a comparable specificity. After 1-hour data entered the model, neither the 6- or the 24-hour data entry improved the overall likelihood ratio statistic, regardless of what VPC grading system was used. These results demonstrate that continuous electrocardiographic recordings of > 1 hour are unnecessary when they are to be used for detecting ventricular arrhythmia as a predictor of mortality in patients surviving a first acute myocardial infarction.
authors.affiliation: Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Petretta
authors.forename: V
authors.initials: V
authors.lastname: Bianchi
authors.forename: A
authors.initials: A
authors.lastname: Pulcino
authors.forename: A
authors.initials: A
authors.lastname: Carpinelli
authors.forename: G
authors.initials: G
authors.lastname: Valva
authors.forename: S
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: T
authors.initials: T
authors.lastname: Attisano
authors.forename: L
authors.initials: L
authors.lastname: Salemme
authors.forename: D
authors.initials: D
authors.lastname: Bonaduce
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005117:Cardiac Complexes, Premature / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity