Predischarge assessment of prognosis after myocardial infarction

This study is a description of the follow up during the first year of 706 consecutive patients admitted at from the coronary care unit of the Thoraxcenter with a proven diagnosis of acute myocardial infarction between March 1981 and December 1983. The main aim, outlined in this chapter, was to assess the relative value of the usual clinical variables compared to that of multiple noninvasive tests at discharge to predict survival after hospital discharge • In chapter 2 we addressed the problem of comparing clinical variables and predischarge bicycle ergometry results to predict mortality and other non-fatal events during follow up. Patients judged non eligible for stress test were separately analyzed. In chapter 3 we assessed the relative merits of clinical data, bicycle ergomet.ry, radionuclide ventriculography and 24-hour ambulatory electrocardiographic monitoring to predict one year survival. Since the 12-lead electrocardiogram is always performed at discharge and since there has recently been renewed interest in the prognostic value of the electrocardiogram in post-infarction patients, we studied in chapter 4 the prognostic value of different variables derived from the electrocardiogram. In particular the risk estimation compared to that obtained from other clinical variables was analyzed. In chapter 5 the follow up is described during the first year of patients with a first myocardial infarction, in terms of their peak serum creatine phosphokinase. The rationale for that analysis was to test whether patients with a small initial infarct were subject to more or fewer ischemic events during follow-up, compared to those with intermediate or large size infarctions. The prognosis of patients below 60 years who survived the hospital phase of a first myocardial infarction with an uncomplicated clinical course, was investigated in Chapter 6. Here the role of exercise testing in guiding the decision to proceed with coronary angiography formed the main study object.