Myocardial infarction: echocardiographic features after 6 weeks helped predict death and heart failure.

Clinical bottom line (level 2b)

  1. 7% of patients who survived 6 weeks following a myocardial infarction died or developed heart failure.
  2. Patients were at increased risk if on 2-D echocardiography at 6 weeks, they had
    • increased end-systolic volume
    • increased end-diastolic volume
    • reduced ejection fraction
Nicolosi et al: European Heart Journal 1996; 17: 1646-1656
Expires March 2003

The study

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

Setting: acute hospitals, Italy

8606 patients (aged ?, 81% male) 6 weeks following acute myocardial infarction

Factors studied:
  • age > 70, sex, previous MI, history of diabetes mellitus, hypertension, anterior MI, Killip class > 1, heart rate > 100 beats/min, systolic blood pressure < 120 mmHg
  • 10% decrease in ejection fraction
  • 10 ml increase in end-systolic volume
  • 10 ml increase in end-diastolic volume


All patients had thrombolytic therapy, aspirin and intravenous beta-blockers. Patients had a 2-D echocardiogram 6 weeks after infarction.

Multivariate regression analysis performed on prognostic factors.

100% followed for 6 months
Outcomes studied:
  • death or non-fatal congestive heart failure
  • non-fatal clinical congestive heart failure
  • death

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
death or non-fatal congestive heart failure 6 months 600/8606 7.0%
(6.4% to 7.5%)		 14
(13 to 16)
non-fatal clinical congestive heart failure 6 months 337/8606 3.9%
(3.5% to 4.3%)		 26
(23 to 29)
death 6 months 263/8606 3.1%
(2.7% to 3.4%)		 33
(29 to 37)

prognostic factor for
death or non-fatal congestive heart failure 		time to outcome adjusted RR
(95% CI)		 NNF+
(95% CI)
10% decrease in ejection fraction 6 months 1.59
(1.48 to 1.71) 		24
(20 to 30)
10 ml increase in end-systolic volume 6 months 1.34
(1.28 to 1.41) 		42
(35 to 51)
10 ml increase in end-diastolic volume 6 months 1.16
(1.12 to 1.20) 		89
(71 to 120)

Comments

  1. Patients were from a randomised controlled trial comparing lisinopril, transdermal nitroglycerin, combined therapy and no therapy.

Citation

  1. Nicolosi GL, Latini R, Marino P, et al: The prognostic value of predischarge quantitative two-dimensional echocardiographic measurements and the effects of early lisinopril treatment on left ventricular structure and function after acute myocardial infarction in the GISSI-3 trial (Gruppo Italiano per lo Studio della Sopravvivenza Nell'infarto Miocardioco). European Heart Journal 1996; 17: 1646-1656
Contributor: Chris Ball and Clare Wotton, October 1999
Reviewer:

Clinical Question.
    Patient acute myocardial infarction
    Intervention or Exposure risk factors
    Outcome death