[Identification of patients at risk of malignant arrhythmia in the 1st year after myocardial infarction].
Two hundred twenty two consecutive patients with acute myocardial infarction were followed for one year. We evaluated the usefulness of late potentials, the spectral analysis, heart rate variability, infarct-related coronary artery, ejection fraction, arrhythmias during Holter monitoring and other clinical variables as risk markers for developing of ventricular arrhythmias and/or sudden death. Twenty four patients (10.8%) had late arrhythmic events: sudden death in 7, sustained ventricular tachycardia in 15 and unexplained syncope in 2. Late potentials had high sensitivity (94%) and negative predictive value (99%), followed by an occluded related-infarct coronary artery (75% sensitivity and 96% negative predictive value). Complex ventricular arrhythmias during Holter monitoring was the test with the highest specificity (92%). A combination of late potentials plus an occluded infarct-related coronary artery or late potentials plus ejection fraction showed 100% sensitivity with 100% negative predictive value. Of the 16 studied variables, 5 had independent and significative value as a predictor of arrhythmic events, these are, according to the relative risk: late potentials (20.2), ejection fraction less than 40% (12.1), complex arrhythmias during Holter monitoring (7.5), the presence of an occluded infarct-related coronary artery (6.4) and anterior myocardial infarction localization (4.5). We consider, that with a combination of simple methods of assessment, we can select a subgroup of survivors of an acute myocardial infarction at high risk of developing ventricular arrhythmias and sudden death, which also identifies patients with low risk for these complications.
Araya-Gómez
V
V
Departamento de electrocardiografía y electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
González-Hermosillo
J A
JA
Casanova Garcés
J M
JM
Colín
L
L
Kershenovich
S
S
Iturralde
P
P
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology; D003645:Death, Sudden / Q000209:etiology; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006334:Heart Function Tests; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012307:Risk Factors
Identificación de los pacientes con riesgo de arritmias malignas en el primer año postinfarto del miocardio.