Risk stratification after myocardial infarction.

Functional risk stratification has been a fruitful new approach to classification and management of patients with acute myocardial infarction. Risk is divided into the functional categories: (1) left ventricular dysfunction; (2) ventricular arrhythmias; and (3) ischemia. Diastolic and systolic left ventricular dysfunction and perhaps aneurysm formation are independent indicators of death. Holter ECG recording of spontaneous ventricular arrhythmias or ventricular arrhythmias induced by programmed ventricular stimulation can identify patients who have a higher risk of dying. Ischemic risk can be identified with accuracy in patients with first inferior myocardial infarction. Coronary angiography is indicated to establish ischemic risk for the following situations (1) angina pectoris with ST depression; (2) non-Q wave infarction (3) inferior infarct with positive exercise test; and (4) anterior infarction with left ventricular ejection fraction between 20% and 40%.