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(Circulation. 2003;107:941.)
© 2003 American Heart Association, Inc.

Clinician Update

Changing Late Prognosis of Acute Myocardial Infarction

Impact on Management of Ventricular Arrhythmias in the Era of Reperfusion and the Implantable Cardioverter-Defibrillator

Stefan H. Hohnloser, MD; Bernard J. Gersh, MB, ChB, DPhil

From the J.W. Goethe University, Department of Medicine, Division of Cardiology, Frankfurt, Germany (S.H.H.), and the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn (B.J.G.).

Correspondence to Dr Bernard J. Gersh, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In science, generally to solve one set of problems may be to create or discover a whole new set, and of no science is this more true than in medicine.

— George P. Elliott, The American Scholar, 1975

Sudden cardiac death (SCD) causes approximately 3 million fatalities in the United States annually.¹ With the advent of the implantable cardioverter-defibrillator (ICD), an intervention that reduces the risk of arrhythmogenic death is available.^2–4 The challenge is to identify risk factors for SCD among most patients at relatively low risk, specifically including survivors of acute myocardial infarction (MI), in an era when the prognosis is substantially better than before the widespread use of reperfusion therapy. As in the description of medicine in the epigraph above, reperfusion therapy has solved one set of problems, but the improved prognosis has generated a whole new set of questions about risk stratification. This review discusses risk stratification in contemporary cardiology for patients after acute MI.

Case Illustration
A 54-year-old man was admitted to the hospital after he experienced severe chest pain for approximately 8 hours. He had an acute anterior Q-wave infarction, and he underwent coronary angiography with subsequent recanalization of a totally occluded left anterior descending coronary artery. In addition, the right coronary artery showed a 50% narrowing. At the time of discharge, echocardiography demonstrated a left ventricular ejection fraction of 33%. Exercise stress testing revealed no evidence of ongoing myocardial ischemia. The patient requested advice concerning his risk for subsequent arrhythmias and SCD.

Implications of Contemporary Therapeutic Guidelines on Mortality After MI
The in-hospital and late . . . [Full Text of this Article]

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