title: First myocardial infarction in patients under 60 years old: the role of exercise tests and symptoms in deciding whom to catheterise.
abstract: 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.
authors.affiliation: Department of Cardiology, Aberdeen Royal Infirmary, Foresterhill.
authors.forename: S J
authors.initials: SJ
authors.lastname: Cross
authors.forename: H S
authors.initials: HS
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Kenmure
authors.forename: S
authors.initials: S
authors.lastname: Walton
authors.forename: K
authors.initials: K
authors.lastname: Jennings
mesh_terms: 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