The high risk patient after recovery from myocardial infarction: recognition and management.

Patients at high risk for recurrent myocardial infarction or death can be identified after recovery from an acute myocardial infarction. Predictors of high risk at the time of initial hospital discharge may vary in different localities depending on the underlying baseline characteristics of the patient cohort. The medical records were analyzed of 139 patients discharged from San Francisco General Hospital after recovery from an acute myocardial infarction between July 1978 and September 1981. Multivariate stepwise discriminant analysis of 20 variables contributing to sudden and total death identified complex ventricular ectopic rhythm as the most important variable, followed by age. Failure to receive chronic long-acting nitrates was an independent variable contributing to total mortality but not to sudden death, while the presence of an initial anterior myocardial infarction and impaired left ventricular function were independent variables contributing to sudden death but not to total mortality. Routine 24 hour ambulatory monitoring, radionuclide ventriculography and submaximal stress tests performed during the second week after recovery from an acute myocardial infarction provide identification of a high risk cohort for subsequent recurrent myocardial infarction or death and permit appropriate interventions designed to lessen risk to be undertaken.