Author + information
- Received August 24, 1987
- Revision received October 29, 1987
- Accepted January 14, 1988
- Published online June 1, 1988.
- Steven P. Schulman, MD,
- Stephen C. Achuff, MD, FACC,
- Lawrence S.C. Griffith, MD, FACC,
- J.O'Neal Humphries, MD, FACC,
- George J. Taylor, MD, FACC,
- E.David Mellits, PhD,
- Marylu Kennedy, RN,
- Rosemary Baumgartner,
- Myron L. Weisfeldt, MD, FACC and
- Kenneth L. Baughman, MD, FACC∗
- ↵∗Address for reprints: Kenneth L. Baughman, MD, Cardiology Division, Johns Hopkins Hospital, Baltimore, Maryland 21205.
The prognostic variables from predischarge coronary angiography and left ventriculography in survivors of acute myocardial infarction during the years 1974 to 1978 were evaluated in 143 patients (≤66 years of age) with documented myocardial infarction who were then followed up prospectively for 5 years. One half of the study population had triple vessel coronary disease (≥50% stenosis). However, only 7% of patients had severely depressed left ventricular function with an ejection fraction ≤29%. Evaluation of the contribution of many clinical and angiographic variables to a first cardiac event (death, nonfatal reinfarction or coronary artery bypass surgery) was considered with Kaplan-Meier actuarial curves and multivariate Cox's hazard function analysis. A risk segment was defined as an area of contracting myocardium supplied by a coronary artery with a > 50% stenosis.
Multivariate analysis demonstrated that right plus left anterior descending coronary artery stenoses (p < 0.01), ejection fraction (p < 0.01) and the presence of risk segments (p < 0.05) were significant predictors of outcome. Furthermore, on separate multivariate analyses, the angiographic variables added significantly to the clinical variables to predict cardiac events over 5 years of follow-up. Therefore, in survivors of acute myocardial infarction who undergo cardiac catheterization, additive prognostic information is obtained that can be used to stratify risk over 5 years.
☆ This study was supported by the United States Public Health Service Ischemic Heart Disease Specialized Center for Research Grant P50HL 17655-12 and General Clinical Research Grant 5M11RR 0072506, Bethesda, Maryland.
- Received August 24, 1987.
- Revision received October 29, 1987.
- Accepted January 14, 1988.