Historically, risk stratification for survivors of acute myocardial infarction (AMI) has centered on 3 principles: assessment of left ventricular function, detection of residual myocardial ischemia, and estimation of the risk for sudden cardiac death. Although these factors still have important prognostic implications for these patients, our ability to predict adverse cardiac events has significantly improved over the last several years. Recent studies have identified powerful predictors of adverse cardiac events available from the patient history, physical examination, initial electrocardiogram, and blood testing early in the evaluation of patients with AMI. Numerous studies performed in patients receiving early reperfusion therapy with either thrombolysis or primary angioplasty have emphasized the importance of a patent infarct related artery for long-term survival. The predictive value of a variety of noninvasive and invasive tests to predict myocardial electrical instability have been under active investigation in patients receiving early reperfusion therapy. The current understanding of the clinically important predictors of clinical outcomes in survivors of AMI is reviewed in this article.

Death, Sudden, Cardiac↗

PubMedDate not supplied

Noninvasive risk assessment after myocardial infarction.

BACKGROUND: Mortality from acute myocardial infarction is substantially less than it was two and even one decade ago. This improvement in both short-term and postdischarge outcome results both from early interventions to restore myocardial perfusion and mitigate expansion and remodeling, and from later assessment and management of functional status at the time of hospital discharge. OBJECTIVE: Recent studies suggest that invasive evaluation of the patient who has had a myocardial infarction (MI) should not be recommended on a routine basis. This review provides an approach to the noninvasive assessment of the patient. DISCUSSION: Stress testing to ascertain post-MI ischemia, ejection fraction determination to evaluate ventricular volumes and function, and ambulatory electrocardiographic monitoring, electrophysiologic study, and signal-averaged electrocardiography to assess presence and type of ventricular ectopy are discussed. CONCLUSION: The approach to the post-MI patient offered herein is felt to be medically sound and cost-effective. Refinement and alterations in this approach will be necessary as outcomes in specific patient groups, such as thrombolysis patients, women, and the elderly, become clearer.

Arrhythmias, Cardiac↗

PubMedDate not supplied

Selection of optimal pacing mode.

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Algorithms↗