To identify predictors of late mortality, 259 consecutive men (less than or equal to 60 years old) who survived acute myocardial infarctions were catheterized one month after admission and were then followed for a mean of 34 months. Nineteen patients (7 per cent) died during the observation period. Of 79 base-line descriptors, 17 proved to be univariate predictors of survival. Cox regression analysis demonstrated that the ejection fraction (P less than 0.001), the number of diseased vessels (P less than 0.005), and the occurrence of congestive heart failure in the coronary unit (P less than 0.01) were the only independent predictors of survival. Risk stratification showed that the probability of survival at four years was highest in patients with normal ejection fractions (96 to 100 per cent, depending on the number of diseased vessels) and lowest in those with ejection fractions below 20 per cent (3o to 75 per cent). The prognosis in patients with ejection fractions between 21 and 49 per cent was significantly worse (78 per cent) than in those with normal ejection fractions only in the group with three-vessel involvement (P less than 0.01). Since most survivors of myocardial infarction who are likely to have their lives prolonged by coronary-artery bypass surgery are in this group, it is reasonable to limit routine coronary angiography to the 56 per cent of survivors who have ejection fractions between 21 and 49 per cent.
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[Abstract][Full Text]
Previtali, M., Fetiveau, R., Lanzarini, L., Cavalotti, C., Klersy, C.
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[Abstract][Full Text]
Mahmarian, J. J., Moye, L. A., Chinoy, D. A., Sequeira, R. F., Habib, G. B., Henry, W. J., Jain, A., Chaitman, B. R., Weng, C. S. W., Morales-Ballejo, H., Pratt, C. M.
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[Abstract][Full Text]
Schneider, C. A., Voth, E., Baer, F. M., Horst, M., Wagner, R., Sechtem, U.
(1997). QT Dispersion Is Determined by the Extent of Viable Myocardium in Patients With Chronic Q-Wave Myocardial Infarction. Circulation
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[Abstract][Full Text]
Haider, A. W., Chen, L., Larson, M. G., Evans, J. C., Chen, M. H., Levy, D.
(1997). Antecedent Hypertension Confers Increased Risk for Adverse Outcomes After Initial Myocardial Infarction. Hypertension
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[Abstract][Full Text]
Carlos, M. E., Smart, S. C., Wynsen, J. C., Sagar, K. B.
(1997). Dobutamine Stress Echocardiography for Risk Stratification After Myocardial Infarction. Circulation
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[Abstract][Full Text]
Holman, E. R., Buller, V. G.M., de Roos, A., van der Geest, R. J., Baur, L. H.B., van der Laarse, A., Bruschke, A. V.G., Reiber, J. H.C., van der Wall, E. E.
(1997). Detection and Quantification of Dysfunctional Myocardium by Magnetic Resonance Imaging: A New Three-dimensional Method for Quantitative Wall-Thickening Analysis. Circulation
95: 924-931
[Abstract][Full Text]
Lehmkuhl, H., Blunck, B., Altstidl, R., Barth, K., Bachmann, K.
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47: 1127-1137
[Abstract]
Kuntz, K. M., Tsevat, J., Goldman, L., Weinstein, M. C.
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94: 957-965
[Abstract][Full Text]
Specchia, G., De Servi, S., Scire, A., Assandri, J., Berzuini, C., Angoli, L., La Rovere, M. T., Cobelli, F.
(1996). Interaction Between Exercise Training and Ejection Fraction in Predicting Prognosis After a First Myocardial Infarction. Circulation
94: 978-982
[Abstract][Full Text]
Kellett, J., Clarke, J.
(1995). Comparison of "Accelerated" Tissue Plasminogen Activator with Streptokinase for Treatment of Suspected Myocardial Infarction. Med Decis Making
15: 297-310
[Abstract]
Misier, A. R. R., Opthof, T., van Hemel, N. M., Vermeulen, J. T., de Bakker, J. M.T., Defauw, J. J.A.M., van Capelle, F. J.L., Janse, M. J.
(1995). Dispersion of `Refractoriness' in Noninfarcted Myocardium of Patients With Ventricular Tachycardia or Ventricular Fibrillation After Myocardial Infarction. Circulation
91: 2566-2572
[Abstract][Full Text]
Lee, K. L., Woodlief, L. H., Topol, E. J., Weaver, W. D., Betriu, A., Col, J., Simoons, M., Aylward, P., Van de Werf, F., Califf, R. M.
(1995). Predictors of 30-Day Mortality in the Era of Reperfusion for Acute Myocardial Infarction : Results From an International Trial of 41 021 Patients. Circulation
91: 1659-1668
[Abstract][Full Text]
Grines, C. L., Topol, E. J., O'Neill, W. W., George, B. S., Kereiakes, D., Phillips, H. R., Leimberger, J. D., Woodlief, L. H., Califf, R. M.
(1995). Effect of Cigarette Smoking on Outcome After Thrombolytic Therapy for Myocardial Infarction. Circulation
91: 298-303
[Abstract][Full Text]
Niemeye, M.G., Van der Wall, E.E., Pauwels, E.K.J., van Dijkman, P.R.M., Blokland, J.A.K., de Roos, A., Bruschke, A.V.G.
(1992). Assessment of Acute Myocardial Infarction by Nuclear Imaging Techniques. ANGIOLOGY
43: 720-733
[Abstract]
Klein, W., Eber, B., Rotman, B.
(1992). Comparative Effects of Digoxin and Xamoterol on Arrhythmias in Patients with Mild to Moderate Heart Failure. ANGIOLOGY
43: 281-286
[Abstract]
Hirsh, J., Cairns, J. A.
(1987). Analytic Reviews : Antithrombotic Tberapy in Acute Myocardial Infarction and Unstable Angina. J Intensive Care Med
2: 299-312
Zema, M. J.
(1985). Prognosis After Myocardial Infarction- Prediction in Ambulatory Patients by Use of the Bedside Valsalva Maneuver. ANGIOLOGY
36: 96-104
[Abstract]
