Risk stratification after myocardial infarction A reappraisal in the era of thrombolysis

Objectives The present study was performed to evaluate whether the modalities of risk stratification after myocardial infarction were still operative in the thrombolytic era. Background Prediction of fatal events in the aftermath of myocardial infarction relies on tests which aim to assess myocardial function, residual ischaemia and propensity for ventricular arrhythmias. Recent data on improved myocardial infarction prognosis have led to the view that risk stratification needs to be updated. Methods In this multicentre, prospective study, 471 acute myocardial infarction patients, 45% of whom were given thrombolytic therapy, were enrolled from the 10th day and underwent all or part of the following tests: exercise test, radionuclide ventriculography (resting and exertional ejection fraction), Holter monitoring, signal-averaged electrocardiography and programmed electrical stimulation. Univariate and multivariate analyses were performed to identify predictors of mortality. Results One year and long-term (mean follow-up 31-4 months) mortality rates were 5-5% and 8-4%, respectively. Prediction of mortality was assessed and the role of the following variables was thus determined: age over 56 years (P=0-01), previous coronary attacks (/ > =0017), maximum workload of