Document Detail

Prognostic importance of myocardial ischemia detected by ambulatory monitoring early after acute myocardial infarction.
MedLine Citation:
PMID:  8531960     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: After an acute myocardial infarction, it is important to determine the risk of a subsequent coronary event. We studied the prognostic value of myocardial ischemia detected by ambulatory electrocardiographic (ECG) monitoring in patients who had recently had an acute myocardial infarction. METHODS: Five to seven days after acute myocardial infarction, 406 patients underwent 48-hour ambulatory ECG monitoring, with submaximal exercise testing before discharge and measurement of the left ventricular ejection fraction within 28 days after infarction. Death, nonfatal myocardial infarction, and admission to the hospital because of unstable angina were the principal end points recorded during the one-year follow-up period. RESULTS: The overall incidence of myocardial ischemia detected by ambulatory ECG monitoring was 23.4 percent. The mortality rates at one year were 11.6 percent among the patients with ischemia and 3.9 percent among those without ischemia (P = 0.009); 3.9 percent among the patients with a positive exercise test, 3.0 percent among those with a negative exercise test, and 16.4 percent among those in whom an exercise test was not performed (P < 0.001); and 3.6 percent among the patients with an ejection fraction greater than 50 percent, 3.5 percent among those with an ejection fraction between 35 and 50 percent, and 18.2 percent among those with an ejection fraction below 35 percent (P = 0.001). Using multiple logistic regression, we found that no diagnostic test performed after myocardial infarction provided additional prognostic information beyond that provided by the standard clinical variables used to predict the risk of death. When nonfatal myocardial infarction and admission to the hospital because of unstable angina were also included as outcome variables, ambulatory monitoring for ischemia was the only test that contributed significantly to the model. For the patients with ischemia detected by ambulatory monitoring, as compared with those who did not have evidence of ischemia, the odds ratio was 2.3 (95 percent confidence interval, 1.2 to 4.5) for death or nonfatal myocardial infarction (P = 0.009) and 2.8 (95 percent confidence interval, 1.6 to 4.8) for death, nonfatal myocardial infarction, or admission to the hospital because of unstable angina (P < 0.001). CONCLUSIONS: Myocardial ischemia detected by ambulatory ECG monitoring is common early after acute myocardial infarction and provides prognostic information beyond that available from standard clinical information.
J B Gill; J A Cairns; R S Roberts; L Costantini; B J Sealey; E F Fallen; C W Tomlinson; M Gent
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  334     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-01-26     Completed Date:  1996-01-26     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  65-70     Citation Subset:  AIM; IM    
Department of Medicine, McMaster University, Hamilton, Ont., Canada.
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MeSH Terms
Angina, Unstable / etiology
Electrocardiography, Ambulatory*
Exercise Test
Logistic Models
Middle Aged
Myocardial Infarction / complications*,  mortality,  physiopathology
Myocardial Ischemia / diagnosis*,  epidemiology,  etiology
Stroke Volume
Comment In:
N Engl J Med. 1996 Jun 6;334(23):1545; author reply 1545-6   [PMID:  8618617 ]
N Engl J Med. 1996 Jun 6;334(23):1545-6   [PMID:  8618618 ]
N Engl J Med. 1996 Jan 11;334(2):113-4   [PMID:  8531943 ]

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