Risk stratification after acute myocardial infarction by Doppler stroke distance measurement.
OBJECTIVE
To establish the value of Doppler stroke distance measurement as a predictor of mortality risk following acute myocardial infarction.


METHODS
Follow up study.


METHODS
Coronary care unit of a teaching and district general hospital.


METHODS
378 patients (mean age 61 years) with acute myocardial infarction followed up for a mean of five years (range 2-7 years); 299 (79%) patients received thrombolysis.


METHODS
Stroke distance (the systolic velocity integral of blood flow in the aortic arch (percentage of age predicted normal value)); presence or absence of left ventricular failure on the admission chest radiograph; the codified admission ECG; death during follow up.


RESULTS
Mean (SD) stroke distance was 81 (19)% and five year survival 76%. For patients with stroke distance > 100% (n = 60), 82-100% (n = 134), 63-81% (n = 122), and < 63% (n = 62), the one month mortality rates were 0%, 1.5%, 4%, and 18%, respectively; the corresponding estimates for mortality at five years were 17%, 19%, 24%, and 43%. Survival was independently related to age (p < 0.0001), stroke distance (p < 0.0001), and chest radiograph appearance (p = 0.002), but not to ECG codes (p = 0.31) or receipt of thrombolysis (p = 0.60). The areas under receiver operator characteristic plots for stroke distance measurements were 82%, 76%, 71%, and 65% for deaths within one month, six months, one year, and two years, respectively.


CONCLUSIONS
The bedside measurement of stroke distance stratifies mortality risk after acute myocardial infarction. The predictive ability of this simple measure of left ventricular systolic function compares well with published accounts of the more complex measurement of ejection fraction.
Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK.
R J
RJ
Trent
J M
JM
Rawles
D000368:Aged; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012372:ROC Curve; D012044:Regression Analysis; D013318:Stroke Volume; D015996:Survival Rate; D016277:Ventricular Function, Left