First myocardial infarction in patients under 60 years old: the role of exercise tests and symptoms in deciding whom to catheterise.
OBJECTIVE
To determine the role of exercise tests and assessment of angina in the detection of potentially threatening disease in young patients with infarcts.


METHODS
Elective readmission of patients at a mean (SD) of 60 (30) days after acute myocardial infarction for assessment of angina, treadmill exercise tests, and cardiac catheterisation.


METHODS
Cardiology department of a teaching hospital.


METHODS
186 consecutive survivors, aged under 60 years and discharged from the coronary care unit after a first myocardial infarction.


METHODS
Coronary arteriography, presence of angina, result of exercise tests, and referral for revascularisation.


RESULTS
31% of patients had either two vessel disease (with proximal left anterior descending involvement), three vessel disease, or left main stem disease. 49% of all patients had angina. Of the 173 patients who had an exercise test 34% had 1 mm and 24% had 2 mm of exercise induced ST depression. Thirty percent had no angina and a negative exercise test: after a mean (SD) follow up of 16 (4) months none of this symptom free sub-group had died, had experienced a further myocardial infarction, or had been referred for revascularisation. 79% of patients with either two vessel disease (with proximal left anterior descending involvement), three vessel disease, or left main stem disease had either angina or a 1 mm ST depression during the exercise test.


CONCLUSIONS
Patients without cardiac pain after myocardial infarction and without ST changes during an exercise do not need arteriography.
Cross
S J
SJ
Department of Cardiology, Aberdeen Royal Infirmary, Foresterhill.
Lee
H S
HS
Kenmure
A
A
Walton
S
S
Jennings
K
K
D000328:Adult; D000787:Angina Pectoris / Q000503:physiopathology; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires