Document Detail


Prognostic impact of demographic factors and clinical features on the mode of death in high-risk patients after myocardial infarction--a combined analysis from multicenter trials.
MedLine Citation:
PMID:  16274095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Contemporary information is lacking on the effect of demographic features and clinical features on the specific mode of mortality after myocardial infarction (MI) in the thrombolytic era. HYPOTHESIS: The aims of this study were (1) to examine the risk and trend of a different mode of mortality (i.e., all-cause, arrhythmic, and nonarrhythmic cardiac mortality) in high-risk patients post MI with reduced left ventricular ejection fraction (LVEF) or ventricular arrhythmias; and (2) to assess the predictive value of demographic and clinical variables in the prediction of specific modes of death in high-risk patients post MI in the thrombolytic era. METHODS: In all, 3,431 patients receiving placebo (2,700 men, median age 64 +/- 11 years) from the EMIAT, CAMIAT, SWORD, TRACE, and DIAMOND-MI studies, with LVEF < 40% or ventricular arrhythmia were pooled. Risk factors for mortality among patients surviving > or = 45 days after MI up to 2 years were examined using Cox regression. Short-term survival (from onset of MI to Day 44 after MI) was also examined for TRACE and DIAMOND-MI, in which patients were recruited within 2 weeks of MI. RESULTS: After adjustment for treatment and study effects, age, previous MI/angina, increased heart rate, and higher New York Heart Association functional class increased the risk of all-cause, arrhythmic, and cardiac mortality. Male gender, history of hypertension, low baseline systolic blood pressure, and Q wave were predictive of all-cause and arrhythmic mortality, whereas diabetes was only predictive of all-cause mortality. Smoking habit and atrial fibrillation had no prognostic value. Similar parameters were also predictive of short-term mortality, but not identical. CONCLUSIONS: Our study has shown that in high-risk patients post MI, who have been preselected using LVEF or frequent ventricular premature beats, demographic and clinical features are powerful predictors of mortality in the thrombolytic era. We propose that demographic and clinical factors should be considered when designing risk stratification or survival studies, or when identifying high-risk patients for prophylactic implantable cardiodefibrillator therapy.
Authors:
Yee Guan Yap; Trinh Duong; J Martin Bland; Marek Malik; Christian Torp-Pedersen; Lars Køber; Stuart J Connolly; Bradley Marchant; A John Camm
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical cardiology     Volume:  28     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-11-08     Completed Date:  2006-02-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  471-8     Citation Subset:  IM    
Affiliation:
Department of Cardiological Sciences, St George's Hospital Medical School, London, UK. ygyap@aol.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Arrhythmias, Cardiac / diagnosis,  mortality,  physiopathology
Blood Pressure / physiology
Cause of Death
Diabetes Mellitus / diagnosis,  mortality,  physiopathology
Female
Heart Rate / physiology
Humans
Male
Middle Aged
Multicenter Studies as Topic
Myocardial Contraction / physiology
Myocardial Infarction / diagnosis*,  mortality,  physiopathology
Prognosis
Prospective Studies
Randomized Controlled Trials as Topic
Risk Factors
Statistics as Topic
Stroke Volume / physiology
Survival Analysis
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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