PMID: 9558693Apr 29, 1998Paper

Stepwise strategy on the cost of risk stratification after acute myocardial infarction: a retrospective simulation study

Pacing and Clinical Electrophysiology : PACE
M OliveiraM Malik

Abstract

Stratification of postinfarction patients at high risk of mortality and/or other adverse events can be improved by combining several prognostic markers. As the clinical impact of risk stratification has only recently emerged in prospective trials, there are a lack of data regarding the cost-effectiveness of multimarker strategies. This study performed a comprehensive search of a postinfarction database and simulated different risk stratification strategies involving left ventricular ejection fraction, signal-averaged electrocardiography, Holter monitoring, and heart rate variability, The parameters were assessed before discharge in 417 survivors of acute myocardial infarction followed-up for 1 year. Cardiac mortality was used as the clinical endpoint. A statistical computer model of a stepwise strategy using every feasible sequence of the four tests was used and, based on prices derived from European and American centers, the cost estimates of all possible combinations were compared. During the 1 year after myocardial infarction there were 24 cardiac deaths (5.8%). In all the population, 6% had all four tests positive (cardiac mortality 20%); 25% had at least three tests positive (cardiac mortality 12.5%); 58% had at least two ...Continue Reading

References

Jan 11, 1992·The American Journal of Cardiology·J S SteinbergJ L Fleiss
Apr 1, 1985·American Heart Journal·M E RosenthalT Peter

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Citations

Dec 12, 2001·Journal of the American College of Cardiology·J J BaileyM Hodges
Jun 27, 2007·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Mário Martins OliveiraJorge Quininha
Feb 1, 2008·Pacing and Clinical Electrophysiology : PACE·Andreas W SchoenenbergerAndreas E Stuck
Jul 11, 2002·Journal of the American College of Cardiology·Antonis A ArmoundasHans D Esperer

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