Multicenter Post-Infarction Program - MPIP
The Multicenter Post-Infarction Program was a prospective, risk-stratification study of the role of physiologic measurements of heart function in patients who survived the coronary care unit phase of an acute myocardial infarction.
Three primary risk variables (an ejction fraction <40%, 10 or more ventricular ectopic depolarizations per hour, and angina pectoris) will have significant, independent effects on survival.
Patients Screened: 4090
Patients Enrolled: 866
NYHA Class: 38% had NYHA Class II-IV at baseline
Mean Follow Up: 1-3 years
Mean Patient Age: <70 years
Mean Ejection Fraction: mean EF=46%
Age <70 years Survived the coronary care unit phase of an acute MI
Life-threatening coexisting disorder Lived at distance from the clinic that travel for follow-up would be unusually difficult
All-cause mortality at 1 year Cardiac mortality due to atherosclerotic coronary heart disease Sudden cardiac death
Two-channel 24-hour Holter recordings were analyzed by computer. Ventricular ectopic depolarizations were categorized by mean frequency per hour. Ejection fractions were determined on the nuclear-medicine equipment available at the respective enrolling institiutions. The development of angina pectoris was defined as precordial pressure-type discomfort in the interim between transfer from the CCU and hospital discharge. Other variables included in the risk stratification analysis for mortality were prior MI, NYHA class, presence of rales while in the CCU, heart rate in the CCU, presence of anterior MI.
The mortality rate was 9% in the first year of follow-up. A progressive increase in cardiac mortality to 1 year was seen as the EF fell below 40% and as the number of ventricular ectopic depolarizations exceeded one per hour. Mortality was increased in patients with EF<40% (RR 2.4, p<0.001), ventricular ectopy of 10 or more depolarizations per hour (RR 1.6, p<0.05), NYHA class II-IV (RR 1.9, p<0.001), and rales (RR 3.3, p<0.001). EF had a stronger effect on mortality than ventricular ectopy of >=10 depolarizations per hour. The lowest risk group was found to be patients with none of the factors (mortality <3% by 2 years; 33% of the population) and the highest risk group was those with all 4 factors (60% mortality; 2% of the population).
Physiologic measurements of heart function along with certain clinical characterisitics permit risk stratifiction in patients surviving the early post-infarction course.
N Engl J Med 1983;309:331-336 Circulation 1984;69:250-258
Keywords: Risk, Myocardial Infarction, Follow-Up Studies, Respiratory Sounds, Heart Rate, Ventricular Premature Complexes
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