title: Residual myocardial ischaemia in first non-Q versus Q wave infarction: maximal exercise testing and ambulatory ST-segment monitoring.
abstract: In a prospective study of 123 consecutive survivors of a first myocardial infarction (43 non-Q wave, 80 Q wave), we determined the total residual ischaemic burden by use of pre-discharge maximal exercise testing and post-discharge 36 h ambulatory ST-segment monitoring initiated 11 +/- 5 days after the infarction. The prevalence of exercise-induced ischaemic manifestations in the infarct types was similar: chest pain 14% vs 16% and ST-segment depression 54% vs 54%. The ischaemic threshold did not differ either (heart rate at 1 mm of ST-segment depression 120 +/- 27 vs 119 +/- 25 beats.min-1). During early post-discharge daily activities, more patients with non-Q wave infarction demonstrated transient episodes of ST-segment depression: 28% vs 14% (ns). Furthermore, ischaemic episodes were significantly longer (42.5 +/- 50.1 vs 22.0 +/- 20.6 min; P < 0.001), and the ischaemic threshold was significantly lower in non-Q wave infarction (heart rate at onset of ST-segment depression 84 +/- 11 vs 88 +/- 9 beats.min-1; P < 0.05). During 3.5 +/- 0.9 years of follow-up the proportion of patients with > or = 1 ischaemic event (non-fatal reinfarction, angina pectoris, revascularization) was significantly higher in non-Q wave infarction (51%) as compared to Q wave infarction (31%) (P < 0.05). In both infarct types the presence of ST-segment depression on ambulatory recording and exercise testing significantly predicted the development of future angina pectoris, whereas patients at increased risk for subsequent non-fatal reinfarction or cardiac death were not identified.
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Mickley
authors.forename: P
authors.initials: P
authors.lastname: Pless
authors.forename: J R
authors.initials: JR
authors.lastname: Nielsen
authors.forename: M
authors.initials: M
authors.lastname: Møller
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D015996:Survival Rate