Immediate and two year prognosis after acute myocardial infarction: prediction from non-invasive as well as invasive parameters in the same individuals

One hundred and thirty-two patients with acute myocardial infarction (AMI) within the preceding 24 h were followed over a two year period. The non-invasive prognostic indices of Norris and Peel were compared to a new invasive prognostic index (PI), derived from heart rate (HR), systolic blood pressure (SBP), pulmonary capillary wedge pressure (PCW), and cardiac index (CI). It was shown that 100×(SBP× CI)/(PCW× HR) proved to be the most discriminant formula to predict outcome. In a second series of 123 individuals, studiedprospectively, this index showed the same discriminatory power. The data indicate further that patients in Norris-classes III- VI should receive hemodynamic monitoring by means of a Swan-Ganz thermodilution catheter and/or arterial line to determine the need and the response to interventions within the first 24 h. In addition, patients in Norris-classes I and II should receive hemodynamic monitoring when severe conduction disturbances, ventricular tachycardia or recurrent ventricular fibrillation, or clinical congestive heart failure are present. Determination of enzyme levels or the occurrence ofVTor VFduring the first 24 h and a variety of non-invasive parameters, such as age, sex and history of a previous myocardial infarction, proved to have little or no value in predicting the immediate or long-term outcome. Only in patients in Norris-classes I and II without any complications, will monitoring of the ECG alone suffice. In these VF or VT will occur sufficiently often to warrant admission to a Coronary Care Unit