Improvement of risk-stratification by use of a new combination of Holter variables in survivors of myocardial infarction.
OBJECTIVE
Holter monitoring is one option in risk-stratification after acute myocardial infarction (MI). Measurements of heart rate variability (HRV), ventricular tachycardia (VT) and ST-segment elevation (ST upward arrow ) have been useful in predicting clinical outcome. We investigated if a combination of different Holter variables could optimize risk-stratification.


METHODS
One hundred and twenty-one men < 70 years old with a first MI were studied. Holter monitoring for 24 h was started 11 +/- 5 days after MI and analysed for HRV, VT and ST. Follow-up was 10-12 years with cardiac death as endpoint.


RESULTS
Thirty-six patients were positive for > or = 1 Holter variable (HRV in 15, VT in 16, ST in 10). At follow-up 22 cardiac deaths had occurred. The prognostic sensitivity of individual Holter variables ranged from 23 to 36%, but increased to 64% if combined. The cardiac death rate in Holter positive patients (39%) was significantly higher than in Holter negative patients (9%) (p < 0.0001).


CONCLUSIONS
By combining measurements of HRV, VT and ST the prognostic importance of Holter monitoring can be significantly improved. The patients can be stratified in a low-risk group with an annual mortality < 1% vs a high-risk group with a cardiac death rate around 40% over the following decade.
Vittrup
Axel
A
Department of Cardiology, Odense University Hospital, Odense, Denmark. axelvittrup@dadlnet.dk
Johansen
Allan
A
Møller
Mogens
M
Mickley
Hans
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy