Risk stratification after acute myocardial infarction by Doppler stroke distance measurement
R J Trenta, J M Rawlesb
a Department of
Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK, b Medicines
Assessment Research Unit, University of Aberdeen, Aberdeen, UK
Correspondence to: Dr R J Trent, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, Clwyd LL13 7TD, UK.
Accepted for publication 13 March 1999
OBJECTIVE
To establish
the value of Doppler stroke distance measurement as a predictor of
mortality risk following acute myocardial infarction.
DESIGN Follow up study.
SETTINGCoronary care
unit of a teaching and district general hospital.
SUBJECTS378 patients
(mean age 61 years) with acute myocardial infarction followed up for a
mean of five years (range 2-7 years); 299 (79%) patients received thrombolysis.
MAIN OUTCOME
MEASURESStroke distance (the systolic velocity
integral of blood flow in the aortic arch (percentage of age predicted
normal value)); presence or absence of left ventricular failure on the
admission chest radiograph; the codified admission ECG; death during
follow up.
RESULTSMean (SD)
stroke distance was 81 (19)% and five year survival 76%. For patients
with stroke distance > 100% (n = 60), 82-100% (n = 134),
63-81% (n = 122), and < 63% (n = 62), the one month mortality
rates were 0%, 1.5%, 4%, and 18%, respectively; the corresponding
estimates for mortality at five years were 17%, 19%, 24%, and 43%.
Survival was independently related to age (p < 0.0001), stroke
distance (p < 0.0001), and chest radiograph appearance
(p = 0.002), but not to ECG codes (p = 0.31) or receipt of
thrombolysis (p = 0.60). The areas under receiver operator characteristic plots for stroke distance measurements were 82%, 76%,
71%, and 65% for deaths within one month, six months, one year, and
two years, respectively.
CONCLUSIONSThe
bedside measurement of stroke distance stratifies mortality risk after
acute myocardial infarction. The predictive ability of this simple
measure of left ventricular systolic function compares well with
published accounts of the more complex measurement of ejection fraction.
Keywords: stroke distance; Doppler; myocardial infarction; mortality risk; risk stratification
© 1999 by Heart
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