Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment era.
OBJECTIVE
Current treatment may have changed the risk profiles of survivors of acute myocardial infarction (AMI). We evaluated the utility of Holter-based risk variables in the prediction of sudden cardiac death (SCD) among survivors of AMI treated with modern therapy.


RESULTS
A total of 2130 AMI patients (mean age 59 +/- 10 years) were included. The patients were treated with modern therapeutic strategies, for example, 94% were on beta-blocking therapy and 70% underwent coronary revascularization. Various risk parameters from Holter monitoring were analysed. During a median follow-up of 1012 days (interquartile range: 750-1416 days), cardiac mortality was 113/2130, including 52 SCDs. All Holter variables predicted the occurrence of SCD (P<0.01), but only reduced post-ectopic turbulence slope (TS) (P<0.001) and non-sustained ventricular tachycardia (P<0.01) remained as marked SCD predictors after adjustment for age, diabetes, and ejection fraction (EF). In a subgroup analysis, none of the Holter variables predicted SCD among those with an EF < or = 0.35, but many variables predicted SCD among those with an EF >0.35, particularly TS (hazard ratio 5.9; 95% CI 2.9-11.7, P<0.001).


CONCLUSIONS
Among the post-AMI patients treated according to the current guidelines, the incidence of SCD is low. Various Holter variables still predict the occurrence of SCD, particularly among the patients with preserved left ventricular function.
Mäkikallio
Timo H
TH
Division of Cardiology, Department of Internal Medicine, University of Oulu, PO Box 5000 (Kajaanintie 50), FIN-90014, Oulu, Finland. timo.makikalio@oulu.fi
Barthel
Petra
P
Schneider
Raphael
R
Bauer
Axel
A
Tapanainen
Jari M
JM
Tulppo
Mikko P
MP
Schmidt
Georg
G
Huikuri
Heikki V
HV
D016757:Death, Sudden, Cardiac / Q000209:etiology*; D015716:Electrocardiography, Ambulatory / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity