[The clinical and prognostic significance of symptomatic and silent ischemia on the exercise test in patients with a prior myocardial infarct].
The aim of the study was to assess clinical/prognostic significance of exercise-induced ischemia in patients with healed myocardial infarction. From May 1988 to January 1991, 777 consecutive patients underwent a symptom-limited (Bruce protocol) treadmill test at least 1 year after myocardial infarction. Clinical and ergometric data were entered in a prospective way in our data base. The exercise-test was positive in 231 out of 777 patients and 2 different subgroups were retrospectively identified depending on criteria of interruption: 156 patients with painless exercise-ST depression; 75 patients with painful exercise-ST depression. The main results (mean +/- SD) were analyzed with Student t test and chi 2 test. Patients with silent ischemia had longer exercise duration (547 +/- 153 s versus 395 +/- 173 s; p < 0.001) and higher double product (22.98 +/- 0.5 versus 19.71 +/- 0.4; p < 0.001) than symptomatic patients. Ischemic threshold was lower (double product: 17.98 +/- 0.4 versus 21.22 +/- 0.4; p < 0.001 with onset of ST depression at 297 +/- 148 s versus 448 +/- 147 s; p < 0.001) and time to ST normalization was longer (368 +/- 155 s versus 234 +/- 212 s; p < 0.001) in patients with painful ischemia. Patients with angina and ST depression had significantly higher prevalence of downsloping ST depression in the recovery phase (68% versus 37%; p < 0.001) and a higher prevalence of treadmill exercise score indicating high risk (49% versus 3.2%; p < 0.001). The 2 groups when compared with 99 patients with negative test post-AMI were significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)
Casella
G
G
Servizio di Cardiologia, Ospedale Maggiore, Bologna.
Pavesi
P C
PC
Mezzetti
M
M
Sangiorgio
P
P
Palmieri
M
M
De Castro
U
U
Bracchetti
D
D
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D016009:Chi-Square Distribution; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D005082:Physical Exertion; D011379:Prognosis; D011446:Prospective Studies
Significato clinico e prognostico dell'ischemia sintomatica e silente al test da sforzo nei pazienti con pregresso infarto miocardico.