Late recurrent ischemia in infarct patients with a normal predischarge exercise test after thrombolysis.
We investigated the prognostic value of normal predischarge exercise test in 109 patients after myocardial infarction treated with i.v. thrombolysis within 4 h. In 29 of these 109 patients, elective PTCA or bypass surgery was performed for prognostic reasons after coronary angiography; 80 patients were treated conservatively with drug therapy. Recurrent postinfarct angina early after hospital discharge was the reason in 4 of 80 for PTCA or bypass surgery. Twenty-three of the remaining 76 conservatively treated patients developed recurrent ischaemia during long-term follow-up of 12.0 +/- 6.2 months, including one patient with reinfarction. Late recurrent ischaemia during long-term follow-up was observed in one third of the conservatively treated patients with a normal predischarge exercise test, although a high percentage (30%) of patients in this subgroup had been treated with PTCA or bypass surgery mainly for prognostic reasons. Predischarge exercise test is therefore of limited value for detection of still viable myocardium at risk of further ischaemic events after acute myocardial infarction and thrombolysis.
Marx
B E
BE
Cardiology Unit, Triemli Hospital, Zurich, Switzerland.
Bertel
O
O
Amann
F W
FW
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D013300:Streptokinase; D010959:Tissue Plasminogen Activator