Myocardial infarction: Killip class, premature ventricular contraction, a previous MI and depression increased the risk of dying.

Clinical bottom line (level 1b)

  1. One in eleven patients with a myocardial infarction were dead within 18 months.
  2. The risk of dying was increased with
    • 10 or more premature ventricular contractions per hour
    • Killip class on admission of 2 or more
    • a previous MI
    • depression
Frasure-Smith et al: Circulation 1995; 91 (4): 999-1005
Expires March 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: tertiary hospital, Canada

222 patients (aged ?: 66% < 65, 77% male) with a myocardial infarction (diagnosed as typical chest pain lasting at least 20 minutes, new Q waves in 2 continuous leads on ECG, and elevated cardiac enzymes)

Excluded if
  • died before discharge
  • MI secondary to coronary artery bypass surgery or angioplasty
  • other condition likely to influence survival
  • inadequate fluency in English or French to complete interviews
  • cognitive difficulties
  • too unwell to complete baseline interview 5 to 15 days post-infarction



    • Factors studied:
  • history of previous MI, left ventricular ejection fraction, Killip class, frequency of premature ventricular contraction on Holter monitoring, thrombolytic therapy, use of beta-blockers or ACE inhibitors
  • 10 or more premature ventricular contractions per hour
  • Killip class II or more
  • previous myocardial infarction
  • depression diagnosed using Beck depression score of 10 or more




    • Logistic regression analysis used to adjust for confounding factors.

    ?100% followed for 18 months
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 18 months 21/222 9.5%
    (5.6% to 13%)    		 11
    (8 to 18)

    prognostic factor for
    death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    10 or more premature ventricular contractions per hour 18 months 10/171
    (5.8%)     		6.06
    (1.90 to 19.4)     		5
    (2 to 21)
    Killip class II or more 18 months 7/175
    (4.0%)     		6.16
    (2.01 to 18.83)     		6
    (3 to 27)
    previous myocardial infarction 18 months 5/140
    (3.6%)     		5.20
    (1.50 to 17.97)     		8
    (3 to 59)
    depression 18 months 4/150
    (2.7%)     		5.62
    (1.41 to 22.5)     		9
    (3 to 94)

    Citation

    1. Frasure-Smith N, Lesperance F, Talajic M: depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91 (4): 999-1005
    Search Terms:
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure Killip class, previous myocardial infarction, depression, premature ventricular contractions
    Outcome death