Bedside risk stratification after acute myocardial infarction: prospective evaluation of the use of heart rate and left ventricular function.
OBJECTIVE
This study evaluated the predictive power of heart rate (HR) assessed from the standard 12-lead electrocardiogram (ECG) or from Holter recordings for future mortality and arrhythmic events in survivors of acute myocardial infarction (AMI).


METHODS
Data from 432 consecutive survivors of AMI (343 men, 89 women; mean [SD] age, 58 [11] years) were analyzed. Heart rate was assessed from a standard 12-lead ECG and from 24-hour Holter recordings obtained at hospital discharge. In addition, left ventricular ejection fraction (LVEF) was noninvasively determined. The study end point was prospectively defined as a composite end point comprising mortality and arrhythmic events (ie, sudden death, resuscitated ventricular fibrillation, sustained ventricular tachycardia). Patients were followed for an average (SD) of 41 (25) months.


RESULTS
Patient age, LVEF, and HR were univariate risk predictors of event-free survival. Multivariate analysis by means of a stepwise regression analysis revealed LVEF ( chi2 11.4, P = .0007), age ( chi 2 9.2, P = .02), and HR assessed from the standard 12-lead ECG ( chi2 7.1, P = .008) as independent risk parameters.


CONCLUSIONS
Bedside risk stratification of survivors of AMI is feasible using simple parameters such as age, LVEF, and HR.
Mauss
Oliver
O
Department of Cardiology, Division of Clinical Electrophysiology, J.W. Goethe University, D-60596 Frankfurt a. main, Germany.
Klingenheben
Thomas
T
Ptaszynski
Pawel
P
Hohnloser
Stefan H
SH
D000328:Adult; D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D018572:Disease-Free Survival; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*