Korean Circ J.  2008 Jan;38(1):17-22. 10.4070/kcj.2008.38.1.17.

Prognostic Significance of the Lown Grades and Late Potentials in Patients after Myocardial Infarction

• Lee JB
• Lee YS
• Hong SP
• Kim SY
• Kim MG
• Ryu JK
• Choi JY
• Kim KS
• Chang SG

• KMID: 2225869
• DOI: http://doi.org/10.4070/kcj.2008.38.1.17

Abstract

BACKGROUND AND OBJECTIVES
The aims of this study were to assess the long term overall survival of patients after an acute myocardial infarction (AMI), and to determine the association of survival with the occurrence of ventricular arrhythmia, as recorded by Holter electrocardiography (ECG) and signal-averaged electrocardiography (SAECG).
SUBJECTS AND METHODS
One hundred fifty two patients with an AMI were enrolled between January 2000 and August 2006. SAECG and Holter ECG were performed before hospital discharge (at range of 2-10 day). The grading system of Lown was used to evaluate the ventricular premature beats on Holter ECG. Three groups of patients were identified based on the seriousness of the ventricular arrhythmia, as identified by the Holter ECG: Lown grade 0, Lown grades 1, 2 and Lown grades 3, 4, 5. SAECG was performed with a high pass frequency of 25 Hz and 40 Hz. The presence of late potentials (LPs) recorded on SAECG was evaluated. The predictors for survival were assessed using Cox's proportional hazard model and Kaplan-Meier analysis.
RESULTS
The mean duration of follow-up was 45.8+/-25.5 months. Twenty four patients (15.8%) died during follow-up. The multivariate predictors of all cause death included age [hazard ratio (HR)=1.25, 95% confidence interval (CI)=1.08-1.47, p=0.003] and Lown grades 3, 4 and 5 (HR=19.17, 95% CI=1.25-290.80, p=0.034). Survival analysis did not show a significant relationship between LPs and overall patient survival. The only predictors for overall mortality were age and the Lown grade.
CONCLUSION
SAECG did not predict mortality for the patient with AMI. The ventricular arrhythmias recorded by conventional Holter before hospital discharge may be a useful noninvasive prognostic test after an AMI.

Keyword

Myocardial infarction; Prognosis; Holter electrocardiography

MeSH Terms

Arrhythmias, Cardiac
Cardiac Complexes, Premature
Electrocardiography
Electrocardiography, Ambulatory
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Myocardial Infarction
Prognosis
Proportional Hazards Models

Figure

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  Fig. 1 Kaplan-Meier analysis of the probability of survival among the patients with acute myocardial infarction and they are divided according to Lown grade. Log rank p=0.006 between groups.

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  Fig. 2 Kaplan-Meier analysis of the probability of survival among the patients with acute myocardial infarction and they are divided according to LPs of 25 Hz. Log rank p=0.050 between the groups. LPs 25 Hz: late potential with a high pass frequency of 25 Hz.

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  Fig. 3 Kaplan-Meier analysis of the probability of survival among the patients with acute myocardial infarction and they are divided according to LPs 40 Hz. p=0.751 between the groups. LPs 40 Hz: late potential with a high pass frequency of 40 Hz.

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