Early exercise test vs. clinical parameters in the long-term prognostic management after myocardial infarction.
An early exercise test was performed in 317 patients with acute myocardial infarction (AMI). The long-term prognosis was assessed after an average follow-up of 5.7 years. The patients with a small increase in the pressure rate product from rest to maximal exercise and/or wih major ventricular arrhythmias constituted a general prognostic high-risk group. The survival was analyzed further applying the above mentioned exercise parameters in the following clinical subgroups: I) patients with clinical heart failure during hospitalization and/or previous myocardial infarction, II) patients with anterior AMI, III) patients with inferior or indefinite AMI. Within each clinical group there was a highly significant difference in survival between the exercise-determined high-risk and low-risk patients. The exercise parameters were more sensitive and more specific prognostic determinators than the clinical variables. The most striking difference was found in patients with clinical heart failure and/or previous infarction. In this group the exercise-determined high-risk patients had a probability of 5-year survival of 0.238 vs. 0.909 in the corresponding low-risk patients (p less than 0.0005).
D000367:Age Factors; D000368:Aged; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D005082:Physical Exertion; D011379:Prognosis; D012306:Risk