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A metaanalysis of predischarge risk stratification after acute myocardial infarction with stress electrocardiographic, myocardial perfusion, and ventricular function imaging.

Publication ,  Journal Article
Shaw, LJ; Peterson, ED; Kesler, K; Hasselblad, V; Califf, RM
Published in: Am J Cardiol
December 15, 1996

We assessed the relation of abnormal predischarge non-invasive test results to outcomes in postmyocardial infarction patients. We included series published from 1980 to 1995 containing only myocardial infarction patients, enrolling most patients after 1980, testing within 6 weeks of infarction, having follow-up rates > 80%, and having 2 x 2 frequency outcome rates for test results, that were the latest of multiple reports. Sensitivity, specificity, and predictive values were calculated for test results for 1-year outcomes (cardiac death, cardiac death or reinfarction). Univariable and summary odds were calculated for test results. Reports (n = 54) included a total of 19,874 patients and were primarily retrospective (76%) and small series (35% of reports included < 5 deaths). One-year mortality ranged from 2.5% for pharmacologic stress echocardiography to 9.3% for exercise radionuclide angiography. Positive predictive values for most noninvasive risk markers were < 0.10 for cardiac death and < 0.20 for death or reinfarction. Electrocardiographic, symptomatic, and scintigraphic risk markers of ischemia (ST-segment depression, angina, a reversible defect) were less sensitive (< or = 44%) for identifying morbid and fatal outcomes than markers of left ventricular dysfunction or heart failure (exercise duration, impaired systolic blood pressure response, and peak left ventricular ejection fraction). The positive predictive value of predischarge noninvasive testing is low. Markers of left ventricular dysfunction appear to be better predictors than markers of ischemia. Limitations of the literature-small samples and widely varying event rates-impede our ability to discern the accuracy of pre-discharge noninvasive testing. More rigorous, controlled trials are required to elucidate the relative value of these tests for risk stratification.

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Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

December 15, 1996

Volume

78

Issue

12

Start / End Page

1327 / 1337

Location

United States

Related Subject Headings

  • Risk Assessment
  • Radionuclide Imaging
  • Prognosis
  • Predictive Value of Tests
  • Odds Ratio
  • Myocardial Infarction
  • Humans
  • Heart
  • Exercise Test
  • Electrocardiography
 

Citation

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Shaw, L. J., Peterson, E. D., Kesler, K., Hasselblad, V., & Califf, R. M. (1996). A metaanalysis of predischarge risk stratification after acute myocardial infarction with stress electrocardiographic, myocardial perfusion, and ventricular function imaging. Am J Cardiol, 78(12), 1327–1337. https://doi.org/10.1016/s0002-9149(96)00653-4
Shaw, L. J., E. D. Peterson, K. Kesler, V. Hasselblad, and R. M. Califf. “A metaanalysis of predischarge risk stratification after acute myocardial infarction with stress electrocardiographic, myocardial perfusion, and ventricular function imaging.Am J Cardiol 78, no. 12 (December 15, 1996): 1327–37. https://doi.org/10.1016/s0002-9149(96)00653-4.
Shaw, L. J., et al. “A metaanalysis of predischarge risk stratification after acute myocardial infarction with stress electrocardiographic, myocardial perfusion, and ventricular function imaging.Am J Cardiol, vol. 78, no. 12, Dec. 1996, pp. 1327–37. Pubmed, doi:10.1016/s0002-9149(96)00653-4.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

December 15, 1996

Volume

78

Issue

12

Start / End Page

1327 / 1337

Location

United States

Related Subject Headings

  • Risk Assessment
  • Radionuclide Imaging
  • Prognosis
  • Predictive Value of Tests
  • Odds Ratio
  • Myocardial Infarction
  • Humans
  • Heart
  • Exercise Test
  • Electrocardiography