title: Exercise-provoked ST-segment depression and prognosis in patients recovering from acute myocardial infarction. Significance and pitfalls.
abstract: The importance of maximal versus submaximal exercise testing and the significance of heart failure on the prognostic value of exercise-provoked ST-segment depression > or = 0.1 mV was studied in 143 patients recovering from acute myocardial infarction. Patients were exercise tested prior to discharge and follow up lasted for up to 18 months (mean 17 months). End-point was first major event (i.e. first non-fatal reinfarction or death). A symptom-limited exercise test was superior to a heart-rate-limited test in detecting ST-segment depressions (27% vs. 20%: P < 0.5), and patients with ST-segment depression at lower heart rates did not have an increased risk of subsequent events compared with patients with ST-segment depression at higher heart rates (14% vs. 27%; NS). Heart failure surpassed ST-segment depression as a risk predictor (34% vs. 18%). Based on a meta-analysis including 13 studies (1987 patients) exercise-provoked ST-segment depression possessed an increased risk of subsequent major events (P < 0.0001; risk ratio = 1.90; 95% confidence limits 1.43,2.51). Thus, ST-segment depression provoked by a symptom-limited test selects patients with an increased risk of subsequent major events. In patients with a history of heart failure exercise-provoked ST-segment depression is of limited value.
authors.affiliation: Municipal Hospital, Medical Department 2, Copenhagen, Denmark.
authors.forename: C M
authors.initials: CM
authors.lastname: Jespersen
authors.forename: L
authors.initials: L
authors.lastname: Hagerup
authors.forename: N
authors.initials: N
authors.lastname: Holländer
authors.forename: J
authors.initials: J
authors.lastname: Launbjerg
authors.forename: N C
authors.initials: NC
authors.lastname: Linde
authors.forename: E
authors.initials: E
authors.lastname: Steinmetz
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005080:Exercise Test; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D016017:Odds Ratio; D011379:Prognosis; D012008:Recurrence