Reduced prognostic power of ventricular late potentials in post-infarction patients of the reperfusion era

• Published in: European heart journal Vol. 26; no. 8; pp. 755 - 761
• Main Authors: Bauer, Axel, Guzik, Przemyslaw, Barthel, Petra, Schneider, Raphael, Ulm, Kurt, Watanabe, Mari A., Schmidt, Georg
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2005; Oxford Publishing Limited (England)
• Subjects: Aged; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Death, Sudden, Cardiac - etiology; Electrocardiography; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Reperfusion - methods; Myocardial Reperfusion - mortality; Myocarditis. Cardiomyopathies; Prognosis; Risk Assessment; Risk Factors; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - mortality; Thrombolytic Therapy - methods; Thrombolytic Therapy - mortality; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - mortality; Ventricular late potentials; Human; Myocardial infarction; Late; Prognosis; Mortality; Cardiovascular disease; Potential; Myocardial disease; Coronary heart disease; Epidemiology; Ventricular late potentials; Reperfusion; Power
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi101

Aims To test the prognostic value of ventricular late potentials (LPs) in a large cohort of post-infarction patients in the modern reperfusion era. Methods and results 1800 consecutive survivors of acute myocardial infarction in sinus rhythm and under 76 years of age were enrolled. Many (99%) of the patients received reperfusion/revascularization therapy (91% percutaneous coronary intervention) and up-to-date pharmacological treatment (99% aspirin, 93% beta-blockers, 90% ACE-inhibitors, and 85% statins). LPs were calculated in 968 patients and found to be present in 90 (9.3%). The primary endpoint was the composite of cardiac death and serious arrhythmic events. The secondary endpoint was the composite of sudden cardiac death and serious arrhythmic events. During follow-up (median 34 months), 26 patients reached the primary endpoint. The presence of LPs was not significantly associated with the primary endpoint in univariable or multivariable analysis. In contrast, low (≤30%) left ventricular ejection fraction (hazard ratio 9.6, 95% confidence interval 4.1–22.4), heart rate turbulence category 2 (7.5, 2.4–23.9) and category 1 (5.3, 1.9–14.9) were significant predictors in both univariable and multivariable analysis. Conclusion Ventricular LPs are of limited use for risk stratification in unselected post-infarction patients in the modern reperfusion era.