Clinical predictors of late death in survivors of acute myocardial infarction.

Survivors of acute myocardial infarction have higher mortality rates than do the general population. This study examined the value of multiple clinical characteristics in predicting late death among patients who present with acute myocardial infarction.We reviewed the electronic medical records of patients who had been treated for acute myocardial infarction at our institution from 1992 through 2000. We abstracted the clinical, laboratory, electrocardiographic, echocardiographic, and treatment characteristics.Of 144 patients (79.2% men; 97.2% white; mean age, 63 +/- 14.2 yr) included in this analysis, 63 (43.8%) patients died during a follow-up period of 5.6 +/- 2.8 years (5 d-12.7 yr). Higher age (hazard ratio, 1.83 +/- 0.31 for every 10-year increase), elevated serum creatinine (hazard ratio, 2.87 +/- 0.76), and lower baseline left ventricular ejection fraction (hazard ratio, 0.74 +/- 0.21 for every 5% increase) were found to be predictors of late death after adjusting for the white blood cell count, the QRS duration, the presence of coronary revascularization or defibrillator implantation, and the history of coronary artery disease. Elevated white blood cell count predicted early but not late death. Patients with none of the above risk factors had 100% survival at 5 years, in comparison with 22.7% survival for those with 3 or more of the 4 risk factors identified above.In this study, we have identified clinical predictors of long-term survival after acute myocardial infarction that might help in prognostication, patient education, and risk modification.