Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy

Abstract

Abstract. Jensen-Urstad M, Samad BA, Jensen-Urstad K, Hulting J, Ruiz H, Bouvier F, Ho Èjer J (Karolinska Hospital, Karolinska Institute, Stockholm; So Èder Hospital, Karolinska Institute, Stockholm; Karolinska Hospital, Karolinska Institute, Stockholm; and So Èder Hospital, Karolinska Institute, Stockholm, Sweden). Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy. J Intern Med 2001; 249: 527±537.Objective. Several noninvasive methods have prognostic information regarding mortality and new coronary events after an acute myocardial infarction (AMI). The practical for clinical decision-making in the immediate postmyocardial infarction (MI) period is, however, less evident. We investigated consecutive patients with AMI treated with thrombolysis to further clarify this issue. Design. A total of 100 patients (27% women) aged 64 9 years (mean SD) were studied. Risk assessment based on a clinical score system, myocardial perfusion scintigraphy single photon emission computed tomography (SPECT) at rest and during adenosine stress, echocardiography, radionuclide angiography, symptom-limited exercise stress test, and 24-h Holter ECG recording with ST-analysis and analysis of heart rate variability (HRV) were performed 5±8 days after hospital admission. Mortality, nonfatal reinfarction, and the need for revascularization were followed during 12 months. Setting. A university hospital. Results. A total of 6 patients died, seven had a nonfatal reinfarction, and 23 were revascularized. Inability to perform an exercise test (P 0.004) and an ejection fraction (EF) <40% (P 0.002) were the only parameters separating those who died from the survivors. No method could predict a nonfatal reinfarction. Patients suffering either death or nonfatal reinfarction had a clinical risk assessment score 2 points higher (8.8 vs. 6.7, P 0.05) than the group without such events. A positive symptomlimited exercise stress test (P 0.027), ST-depressions on Holter ECG (P 0.04), and reversibility on myocardial perfusion scintigraphy (P 0.029) predicted the need for revascularization. Conclusion. Risk assessment based on clinical information, exercise stress testing, and an estimate of left ventricular function (e.g. via echocardiography) contribute with prognostic information in thrombolysed MI-patients. Additional noninvasive investigations such as adenosine-SPECT, analysis of HRV, and Holter-monitoring do not add to these commonly available tools in risk strati®cation of subjects at low to medium risk.

Molecular Basis of Cardioprotective Effect of Antioxidant Vitamins in Myocardial Infarction

“…Both chemical forms are transported intracellularly [110], a process that requires the participation of specific transporters at the level of the plasma membrane [110]. Once inside the cells, DHA is rapidly reduced to ascorbic acid [111, 112]. …”

The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention

“…Among others, global left ventricular function has always been viewed as an important prognostic factor after acute myocardial infarction. Earlier trials in large cohorts of STEMI-patients, treated with either thrombolytic agents or supportive care (no reperfusion-therapy), have confirmed this prognostic value for a period of six months after myocardial infarction [ 3 - 7 ].…”