Risk Factors that Predict Fatal and Nonfatal Cardiac Events

Abstract

The basis for therapeutic decision making is the clinician’s estimate of the risk of unwanted events using one therapy versus another. In the patient with ischemic heart disease the major adverse events that are difficult to anticipate are myocardial infarction (Ml) and sudden death. Death from progressive heart failure can be predicted more easily and will not be discussed further. If a physician is to make a prediction of the patient’s risk, an understanding of the factors associated with these events is necessary. Increasing insight into these factors has been gained by the recent development of statistical methods for predictive models based on pathophysiology. In ischemic heart disease one would hope that the factors predicting MI reflect the likelihood of coronary thrombosis, while the factors predicting sudden death reflect “electrical instability.” If the risk factors for each end point were distinct, specific therapies could be designed to prevent particular events by altering those risk factors.