Prognosis after recovery from first acute myocardial infarction: Determinants of reinfarction and sudden death

• Published in: The American journal of cardiology Vol. 53; no. 4; pp. 408 - 413
• Main Authors: Norris, Robin M., Barnaby, Peter F., Brandt, Peter W.T., Geary, Grayson G., Whitlock, Ralph M.L., Wild, Christopher J., Barratt-Boyes, Brian G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-1984
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Cineangiography; Coronary Artery Bypass; Death, Sudden - etiology; Exercise Test; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Prognosis; Recurrence; Risk; Stroke Volume
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(84)90003-1

Factors associated with total cardiac mortality, sudden cardiac death and reinfarction were studied in 325 male survivors aged younger than 60 years of age (mean 50) of a first myocardial infarction (MI). All patients had undergone exercise testing and cineangiocardiography 4 weeks after MI, 24% underwent coronary artery surgery and 30% received β-blocking therapy. Patients were followed 1 to 6 years (mean 3.5). Total cardiac mortality was best predicted by the left ventricular (LV) ejection fraction (EF) and by a coronary prognostic index. In contrast, neither the severity of coronary arterial lesions measured with a scoring system nor the results of the exercise test gave significant prediction of mortality. Of the 2 major late sequelae of MI, reinfarction could not be predicted by any clinical or cineangiocardiographic variable. However, sudden death not associated with reinfarction was significantly more common (p <0.001) when EF was <-40% than when it was >40%. Comparison of patients with an EF <-40% who did or did not die suddenly showed that LV dilation (high volumes at ventriculography) was an added risk factor, but the extent of coronary occlusions and stenoses was not.
It is concluded that, at least for groups of patients treated with standard modern methods after MI, the main determinant of medium-term survival is the extent of LV damage. The state of the coronary arteries and the presence of ischemic myocardium during exercise are only of secondary importance for survival.