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(Circulation. 2008;118:1312-1313.)
© 2008 American Heart Association, Inc.

Editorial

A Plethora of Prognostic Pearls

Joseph S. Alpert, MD

From the Department of Medicine, University of Arizona College of Medicine, Tucson.

Correspondence to Joseph S. Alpert, MD, Head of Department of Medicine, University of Arizona Health Science Center, 1501 N Campbell Ave, No. 6334, Tucson, AZ 85724–5034. E-mail jalpert@email.arizona.edu

Key Words: Editorials • angioplasty • arteriosclerosis • myocardial infarction • prognosis • reperfusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

"In acute diseases it is not quite safe to prognosticate either death or recovery."

— Hippocrates, Aphorisms, II, 19

The modern cardiologist would probably not agree with Hippocrates’ reluctance to prognosticate about the likely outcome for a patient who presents today with an acute myocardial infarction (AMI). In fact, prognostic indicators have been available for patients with AMI since the earliest days of specialized coronary care. Two of the earliest prognostic instruments were the Killip and Norris indexes, which were derived from observations made in the first dedicated coronary care units during the 1960s.^1,2 Interestingly, these 2 early prognostic indicators for AMI patients are still useful and have retained their accuracy in the late 20th and early 21st centuries.^3–6

Article p 1335

The Norris and Killip prognostic indexes for AMI patients were based on clinical signs and symptoms that correlated with the extent of post-MI left ventricular dysfunction. Since their advent, a plethora of additional prognostic indicators have been described for patients with AMI. Indeed, in an in-depth review of risk stratification in the reperfusion era of AMI therapy, Michaels and Goldschlager⁷ found 42 different variables that independently predicted morbidity and mortality in post-MI patients. These investigators separated prognostic AMI variables into 6 categories related to their source: clinical variables (eg, age, gender, left ventricular dysfunction, and diabetes), physical examination variables (eg, congestive heart failure, S₃, and hypotension), exercise test variables (eg, duration of exercise and magnitude of ischemic ST-segment depression), ECG variables (eg, conduction defects, atrioventricular block, and . . . [Full Text of this Article]