Admission clinical and electrocardiographic characteristics predicting an increased risk for early reinfarction after thrombolytic therapy

• Published in: The American heart journal 1998-05, Vol.135 (5), p.805-812
• Main Authors: Birnbaum, Yochai, Herz, Izhak, Sclarovsky, Samuel, Zlotikamien, Bruria, Chetrit, Angela, Olmer, Liraz, Barbash, Gabriel I.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Comorbidity; Confidence Intervals; Diabetes Complications; Diabetes Mellitus - mortality; Electrocardiography; Female; Hospital Mortality; Humans; Hypertension - complications; Hypertension - mortality; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Patient Admission; Pharmacology. Drug treatments; Recurrence; Reproducibility of Results; Risk Factors; Smoking - adverse effects; Smoking - epidemiology; Survival Rate; Thrombolytic Therapy
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(98)70038-9

Background: This study assessed the ability of clinical and electrocardiographic variables routinely obtained on admission to identify patients with acute myocardial infarction treated with thrombolytic therapy at risk of early reinfarction. Methods and Results: The study included 2602 patients who received thrombolytic therapy for acute myocardial infarction. Baseline demographic variables and admission clinical and electrocardiographic variables were compared between patients with and without reinfarction. Multivariable logistic regression technique was used and included recurrent infarction as the dependent variable, and baseline demographic, clinical, and electrocardiographic variables as independent variables. History of hypertension (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.00 to 2.31) and diabetes mellitus (OR 1.59, 95% CI 1.00 to 2.53) were associated with a higher risk, and current smoking was associated with a lower risk (OR [no versus yes] 1.64, 95% CI 1.05 to 2.58) of early hospital reinfarction. Distortion of the terminal portion of the QRS complex (OR 1.86, 95% CI 1.20 to 2.87) and absence of abnormal Q waves on admission (OR 1.54, 95% CI 0.98 to 2.43) were associated with increased risk of early reinfarction. Conclusions: A simple electrocardiographic sign is a reliable predictor of early reinfarction among patients who receive thrombolytic therapy for acute myocardial infarction. (Am Heart J 1998;135:805-12.)