1- and 7-year risk of cardiac events in relation to Holter monitoring in patients admitted with chest pain in whom AMI is not confirmed

Abstract

The prognostic value of ventricular premature beats (VPBs) was evaluated in 198 patients with chest pain (non-AMI patients) in whom the diagnosis of acute myocardial infarction was ruled out after admission to hospital. VPBs were registered at the time of discharge during a 24-hour Holter monitoring. The amount of cardiac events (CEs) were analyzed after 1 and 7 years follow-up. After 1 year, CEs were seen in 9% of the non-acute myocardial infarction (AMI) patients. After 7 years, 51 CEs (20 nonfatal AMIs and 31 cardiac deaths) had occurred (25%). After 1 year, only pairs of VPBs were associated with an increased risk of CEs. CEs were seen in 25% of the patients with pairs of VPBs and in 6% of the patients without pairs (p<0.01). The occurrence of CEs after 7 years was related to the presence of pairs of VPBs and multiform VPBs. Fifty-five percent of the patients with pairs of VPBs had CEs during the long-term follow-up, compared with 22.5% without pairs (p<0.0005). CE was seen in 48.9% of the patients with multiform VPBs, compared with 19.0% without multiform VPBs (p< 0.0001). Thus, Holter monitoring seems to be of better value for predicting long-term prognosis than for predicting short-term prognosis in non-AMI patients. The presence of multiform VPBs or pairs of VPBs is strongly associated with an increased risk of CE after 7 years. Non-AMI patients with pairs of VPBs or multiform VPBs should be considered as high-risk patients.