Risk Stratification after Myocardial Infarction in Scotland

1998 ◽  
Vol 43 (3) ◽  
pp. 72-73 ◽  
Author(s):  
I. R. Mahy ◽  
G. S. Hillis ◽  
K. P. Jennings
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Risk Stratification ◽  
Resource Limitation ◽  
Postal Questionnaire ◽  
Non Invasive ◽  
Clinical Scenarios ◽  
Q Wave

The objective was to determine how patients are selected for invasive investigation after myocardial infarction in Scotland Cardiologists in Scotland were surveyed by postal questionnaire asking them to detail their approach to four sample clinical scenarios. Complete responses were obtained from 82% of those surveyed Substantial differences in practice were observed in the management of subjects with non-Q wave myocardial infarction. Of the cardiologists surveyed 40% would undertake coronary angiography irrespective of the results of non-invasive testing in a 45 year old patient, but only one would adopt the same policy in an otherwise fit 77 year old Only 44% would perform any investigations (beyond echocardiography) in the 77 year old A minority of respondents felt that their practice was influenced by resource limitation. Considerable variation continues to exist in the approach to risk stratification after myocardial infarction for some groups of patients. This variation may occur principally as a consequence of physician preference.

scholarly journals Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: the PRESERVE EF study

2019 ◽  
Vol 40 (35) ◽  
pp. 2940-2949 ◽  
Author(s):  
Konstantinos A Gatzoulis ◽  
Dimitrios Tsiachris ◽  
Petros Arsenos ◽  
Christos-Konstantinos Antoniou ◽  
Polychronis Dilaveris ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Primary Endpoint ◽  
Predictive Value ◽  
Sustained Ventricular Tachycardia ◽  
Post Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Non Invasive

Abstract Aims Sudden cardiac death (SCD) annual incidence is 0.6–1% in post-myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF)≥40%. No recommendations for implantable cardioverter-defibrillator (ICD) use exist in this population. Methods and results We introduced a combined non-invasive/invasive risk stratification approach in post-MI ischaemia-free patients, with LVEF ≥ 40%, in a multicentre, prospective, observational cohort study. Patients with at least one positive electrocardiographic non-invasive risk factor (NIRF): premature ventricular complexes, non-sustained ventricular tachycardia, late potentials, prolonged QTc, increased T-wave alternans, reduced heart rate variability, abnormal deceleration capacity with abnormal turbulence, were referred for programmed ventricular stimulation (PVS), with ICDs offered to those inducible. The primary endpoint was the occurrence of a major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or SCD. We screened and included 575 consecutive patients (mean age 57 years, LVEF 50.8%). Of them, 204 (35.5%) had at least one positive NIRF. Forty-one of 152 patients undergoing PVS (27–7.1% of total sample) were inducible. Thirty-seven (90.2%) of them received an ICD. Mean follow-up was 32 months and no SCDs were observed, while 9 ICDs (1.57% of total screened population) were appropriately activated. None patient without NIRFs or with NIRFs but negative PVS met the primary endpoint. The algorithm yielded the following: sensitivity 100%, specificity 93.8%, positive predictive value 22%, and negative predictive value 100%. Conclusion The two-step approach of the PRESERVE EF study detects a subpopulation of post-MI patients with preserved LVEF at risk for MAEs that can be effectively addressed with an ICD. Clinicaltrials.gov identifier NCT02124018

scholarly journals Risk stratification of patients with non-Q wave myocardial infarction. The critical role of ST segment depression. The Diltiazem Reinfarction Study Research Group.

Circulation ◽  
1989 ◽  
Vol 80 (5) ◽  
pp. 1148-1158 ◽  
Author(s):  
K B Schechtman ◽  
R J Capone ◽  
R E Kleiger ◽  
R S Gibson ◽  
D J Schwartz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
Research Group ◽  
Critical Role ◽  
Study Research ◽  
St Segment ◽  
Q Wave

P1253Long-term risk stratification of patients undergoing coronary angiography according to the TIMI risk score for secondary prevention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Zafrir ◽  
S Adawi ◽  
M Khalaily ◽  
R Jaffe ◽  
A Eitan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Risk Stratification ◽  
Secondary Prevention ◽  
Risk Score ◽  
Real World ◽  
Risk Indicators ◽  
Artery Disease

Abstract Background A risk score for secondary prevention after myocardial infarction (TRS2P) was recently developed from the TRA2°P-TIMI50 trial based on 9 established clinical factors [age≥75, hypertension, diabetes, smoking, kidney dysfunction, peripheral artery disease, heart failure, prior stroke and prior coronary artery-bypass surgery (CABG)], classifying the risk for major adverse cardiovascular events (MACE). We aimed to evaluate the performance of TRS2P for predicting long-term outcomes in real-world patients presenting for coronary angiography. Methods Retrospective analysis of 13,593 patients that were referred to angiography for the assessment or treatment of coronary artery disease between 2000–2015 in a single center. Risk stratification for 10-year MACE (myocardial infarction, ischemic stroke or all-cause death) was performed using the TRS2P score, divided into 6 categories (0 to ≥5 points), and in relation to the presenting coronary syndrome. Results All clinical variables, except of prior CABG, were independent risk predictors. The annualized incidence rate of MACE increased in a graded manner with increasing TRS2P score, ranging from 1.65 to 16.6 per 100 person-years (ptrend<0.001). The pattern was similar for 10-year cumulative incidence of MACE. Compared to the lowest-risk group (risk indicators=0), the hazard-ratios (95% confidence interval) for MACE were 1.60 (1.36–1.89), 2.58 (2.21–3.02), 4.31 (3.69–5.05), 6.43 (5.47–7.56) and 10.03 (8.52–11.81), in those with 1,2,3,4 and ≥5 risk indicators, respectively. Risk gradation was consistent across the individual clinical endpoints. TRS2P score showed reasonable discrimination with c-statistics of 0.704 for MACE and 0.735 for mortality. The graded relationship between the risk score and event rates was observed in both patients presenting with acute and non-acute coronary syndromes. Cumulative 10-year incidence of MACE Conclusions The use of TRS2P, a simple risk score based on routinely collected variables, enables risk stratification in patients undergoing coronary angiography. Its predictive value was demonstrated in real-world setting with long-term follow-up, and irrespective of the acuity of coronary presentation. Acknowledgement/Funding None

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