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June 27, 2026EP EuropaceOpen Access

Two-step risk algorithm predicts major arrhythmias with 100% sensitivity in post-MI patients with LVEF ≥40%.

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Why the study?

Does a two-step risk stratification algorithm using non-invasive risk factors and programmed ventricular stimulation predict major arrhythmic events in post-myocardial infarction patients with LVEF ≥40%?

Population

575 consecutive post-myocardial infarction patients with mid-range and preserved LVEF, mean age 57 years…

Design

Cohort

Follow-up

mean 106 ± 14.5 months

Key result

A two-step risk stratification algorithm including programmed ventricular stimulation predicted major arrhythmic events in post-MI patients with LVEF ≥40% with 100% sensitivity and 94.8% specificity.

Authors

IDI DoundoulakisDTD TsiachrisPAP Arsenos

Discussion

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Overview

Supports combined NIRF-PVS strategy for ICD selection decisions; extends prior validation with long-term confirmation in a large cohort.

Key Points

  • The study aims to refine risk stratification for arrhythmic events in post-myocardial infarction patients with preserved ejection fraction.
  • Included 575 post-MI patients with preserved left ventricular ejection fraction for analysis.
  • Utilized a two-step algorithm incorporating programmed ventricular stimulation to identify high-risk individuals.
  • Evaluated major arrhythmic events over an 8-year follow-up period.
  • No sudden cardiac deaths were observed during the follow-up.
  • ICDs were appropriately activated in 29.3% of patients with an LVEF of 40-50% and STEMI.
  • The proposed risk assessment had a sensitivity of 100% and specificity of 94.8%.

Study Design

Type

Observational (n=575)

Structured PICO

Does a two-step risk stratification algorithm using non-invasive risk factors and programmed ventricular stimulation predict major arrhythmic events in post-myocardial infarction patients with LVEF ≥40%?

P
Population
575 post-myocardial infarction patients with LVEF ≥40%, mean age 57 years, followed for a mean of 106 months to assess arrhythmic risk.
E
Exposure
Two-step risk stratification algorithm (non-invasive risk factors followed by programmed ventricular stimulation) to guide implantable cardioverter-defibrillator (ICD) implantation
O
Outcome
Major arrhythmic event (MAE), defined as sustained ventricular tachycardia/fibrillation, appropriate ICD activation, or sudden cardiac death (SCD)composite

A two-step risk stratification approach using non-invasive risk factors and programmed ventricular stimulation effectively identifies post-MI patients with LVEF ≥40% at risk for major arrhythmic events, with a 100% negative predictive value.

Limitations

  • Observational structure
  • observational structure

Cite This Study

Doundoulakis et al. (2026) conducted an observational in Post-myocardial infarction with preserved ejection fraction (n=575). Two-step risk stratification algorithm including programmed ventricular stimulation was evaluated on Major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or sudden cardiac death (SCD). A two-step risk stratification algorithm including programmed ventricular stimulation predicted major arrhythmic events in post-MI patients with LVEF ≥40% with 100% sensitivity and 94.8% specificity.

synapsesocial.com/papers/6a3f97e8125782b61d865adbhttps://doi.org/10.1093/europace/euag105.1012
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