Timing of stress testing in an asymptomatic survivor of inferior myocardial infarction.
Exercise electrocardiography with or without thallium-201 scintigraphy was performed (pre-hospital discharge) in 66 asymptomatic survivors of a first inferior myocardial infarction (IMI). Although coronary angiography revealed an 82% incidence of multivessel coronary artery disease (MV-CAD) in the total cohort, the sensitivity of exercise ECG for MV-CAD in the group with absent anterior ST-depression in the acute phase was low (11%). In contrast the presence of acute phase anterior ST-segment depression improved the yield for MV-CAD to 55%. Forty-six patients agreed to a symptom-limited exercise ECG plus/minus thallium imaging at 8-10 weeks post IMI. The sensitivity of detecting MV-CAD improved by 15% in patients with no acute phase anterior ST-segment depression and 16% in patients with acute phase anterior ST-segment depression. At each exercise protocol, thallium improved the sensitivity of exercise in detecting ischemia in the noninfarct zone. It is concluded that following IMI, a high percentage of asymptomatic patients whose acute phase ECG showed anterior ST-segment depression will have MV-CAD detected by heart-rate limited and, more so, by symptom-limited exercise ECG. The detection rate will double in patients with no anterior ST-segment depression if exercise testing is delayed until 8-10 weeks post IMI.
Hayat
N H
NH
Department of Internal Medicine and Cardiology, Kuwait University, School of Medicine, Safat.
Mohamed
M M
MM
al-Khafaji
M
M
Charvat
J
J
Bhatnagar
S
S
D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D006321:Heart / Q000000981:diagnostic imaging; D006334:Heart Function Tests; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D011877:Radionuclide Imaging; D013312:Stress, Physiological / Q000503:physiopathology*; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D013997:Time Factors
D013794:Thallium Radioisotopes