Ambulatory blood pressure monitoring early after acute myocardial infarction: development of a new prognostic index

Aim: To assess the usefulness of ambulatory blood pressure monitoring (ABPM) in the prognostic stratification of patients with a recent myocardial infarction. Method: The study population included 75 patients consecutively admitted at our institution for acute ST-segment elevation myocardial infarction (STEMI). All patients underwent ABPM 3 weeks after discharge and were subsequently followed for 12 months. Results: The age (Y), mean 24-hour diastolic blood pressure (mDBP) and mean 24-hour beat-to-beat interval (mBBI) values were found to be independent predictors of the combined endpoint of cardiac death and symptomatic left ventricular dysfunction during the follow-up period. A prognostic index was then developed from such variables, according to the formula (mDBP + mBBI/10) – Y. This index, when considered as a categorical variable, in its ‘low’ figures (cut-off <88), showed a significant prognostic value (p < 0.0001). The predictive value of the index for the combined endpoint was higher than left ventricular ejection fraction (50% versus 36%).