[Prognostic and diagnostic value of the exercise test and early coronary anamnesis in patients with myocardial infarct studied in a median term follow-up].
We performed a maximal or symptom limited exercise stress test (ET) 58 +/- 20 days after acute myocardial infarction (AMI) and looked for the presence of angina (A) 4-5 weeks after AMI in 193 consecutive patients (pts.). The aim of the study was to research from ET and history of early A parameters able to predict further coronary events in the follow-up (FU): new onset of angina, reinfarction or cardiac death. The FU lasted 18.06 months. The drop-out was 7%; so, data was collected on 179 pts.; 95% of our population performed the ET without any therapy. 72 pts. (40%) had an anterior-lateral AMI (I group) and 107 (60%) had an inferior-posterior AMI (II group). Pts. with early A were 35% in the I group (GR) and 52% in the II GR (P less than 0.02). Pts. with a positive ET were 38% in the I Gr and 57% in the II GR (P less than 0.01). The double product (DP) of positive ETs in the I GR was inferior (P less than 0.01) to that of the II GR; the DP of negative ETs in the I GR was inferior (P less than 0.01) to that of II GR. The comparison of the DP of positive and negative ETs showed that the former was inferior either in the I GR (P less than 0.02) or in the II GR (P less than 0.05). The highest value of serum CPK of the acute phase was observed in pts. with ST depression during ET in both groups. In the early phase after AMI, ET and A identified 50% of pits. in the I GR and 74% in the II GR as having further signs of coronary artery disease. These data were confirmed during the FU; the two techniques are then complementary to predict further events in our FU. Incidence rate of early symptoms, ischemic responses to ET, work capacity and DP values obtained during ET differed significantly in the two GRs. Reinfarction rate was 5% in the I GR and 10% in the II GR; mortality rate was similar (4.5%) in both GRs; we dit not identify predictive signs for mortality after 18.06 months from AMI. A negative history of A and a negative ET were predictors of absence of angina, but not of reinfarction nor of coronary death during our FU.
D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology*; D004796:Clinical Enzyme Tests; D003402:Creatine Kinase / Q000097:blood; D005080:Exercise Test; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D011379:Prognosis
D003402:Creatine Kinase
Valore prognostico e diagnostico della prova da sforzo e dell'anamnesi coronarica precoce in pazienti con infarto miocardico in un follow-up a medio termine.