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Titolo:
Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy
Autore:
Jensen-Urstad, M; Samad, BA; Jensen-Urstad, K; Hulting, J; Ruiz, H; Bouvier, F; Hojer, J;
Indirizzi:
Soder Hosp, Karolinska Inst, Dept Med, Stockholm, Sweden Soder Hosp Stockholm Sweden arolinska Inst, Dept Med, Stockholm, Sweden Karolinska Hosp, Karolinska Inst, Dept Clin Physiol, S-17176 Stockholm, Sweden Karolinska Hosp Stockholm Sweden S-17176 siol, S-17176 Stockholm, Sweden Soder Hosp, Karolinska Inst, Dept Clin Physiol, Stockholm, Sweden Soder Hosp Stockholm Sweden Inst, Dept Clin Physiol, Stockholm, Sweden
Titolo Testata:
JOURNAL OF INTERNAL MEDICINE
fascicolo: 6, volume: 249, anno: 2001,
pagine: 527 - 537
SICI:
0954-6820(200106)249:6<527:RAIPWA>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
HEART-RATE-VARIABILITY; VENTRICULAR ARRHYTHMIAS; DELAYED RECOVERY; HEALTHY-SUBJECTS; PROGNOSTIC VALUE; MORTALITY; PERFUSION; STRATIFICATION; DETERMINANTS; SURVIVORS;
Keywords:
myocardial infarction; prognosis; risk assessment; thrombolysis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Jensen-Urstad, M Karolinska Hosp, Karolinska Inst, Dept Cardiol, S-17176 Stockholm, Sweden Karolinska Hosp Stockholm Sweden S-17176 ckholm, Sweden
Citazione:
M. Jensen-Urstad et al., "Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy", J INTERN M, 249(6), 2001, pp. 527-537

Abstract

Objective. Several noninvasive methods have prognostic information regarding mortality and new coronary events after an acute myocardial infarction (AMI). The practical for clinical decision-malting in the immediate postmyocardial infarction (MI) period is, however, less evident. We investigated consecutive patients with AMI treated with thrombolysis to further clarify this issue. Design. A total of 100 patients (27% women) aged 64 +/- 9 years (mean +/- SD) were studied. Risk assessment based on a clinical score system, myocardial perfusion scintigraphy single photon emission computed tomography (SPECT) at rest and during adenosine stress, echocardiography, radionuclide angiography, symptom-limited exercise stress test, and 24-h Holter ECG recording with ST-analysis and analysis of heart rate variability (HRV) were performed 5-8 days after hospital admission. Mortality, nonfatal reinfarction, and the need for revascularization were followed during 12 months. Setting. A university hospital. Results, A total of 6 patients died, seven had a nonfatal reinfarction, and 23 were revascularized. inability to perform an exercise lest (P = 0.004)and an ejection fraction (EF) <40% (P = 0.002) were the only parameters separating those who died from the survivors. No method could predict a nonfatal reinfarction. Patients suffering either death or nonfatal reinfarction had a clinical risk assessment score 2 points higher (8.8 vs. 6.7, P = 0.05) than the group without such events. A positive symptom-limited exercise stress test (P = 0.027), ST-depressions on Holter ECG (P = 0.04), and reversibility on myocardial perfusion scintigraphy (P = 0.029) predicted the needfor revascularization. Conclusion. Risk assessment based on clinical information, exercise stresstesting, and an estimate of left ventricular function (e.g. via echocardiography) contribute with prognostic information in thrombolysed MI-patients. Additional noninvasive investigations such as adenosine-SPECT, analysis ofHRV, and Holter-monitoring do not add to these commonly available tools inrisk stratification of subjects at low to medium risk.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 07:12:57