High- and low-risk groups: early and late prognostic stratification

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Prognostic data obtained from studies carried out since the advent of thrombolysis confirm the notion that short-term survival after acute myocardial infarction is primarily influenced by age and clinical indicators of infarct size or global left ventricular dysfunction. In survivors of the in-hospital phase of infarction, markers of left ventricular failure or dysfunction are still the most powerful risk predictors, whereas qualitative variables related to residual ischaemia do not predict outcome. The relatively low overall risk profile of survivors of the in-hospital phase of infarction in the GISSI-2 study appears to reflect favourable changes in the sizes of risk strata that result from a general improvement in management strategies.

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