[Is the predischarge exercise test valid in patients younger than 40 years old after myocardial infarct for determination of multivascular disease?].
OBJECTIVE
Conventional exercise testing before hospital discharge is the most useful procedure in order to estimate postinfarction prognosis and in detecting multivessel coronary disease which is associated with a poor long-term prognosis. There are no bibliographic reports about it in younger myocardial infarction survivors. The aim of the study was to evaluate sensitivity, specificity and predictive value of symptoms limited maximal exercise testing for multivessel disease diagnosis in young patients after myocardial infarction.


METHODS
Myocardial infarction survivors until the age of 40 performed symptoms limited maximal exercise testing and had a coronary arteriography before hospital discharge.


RESULTS
A total of 100 consecutive patients were included, although in only 83 of them exercise tests and coronariographic studies were done. In this group, multivessel disease was confirmed in 27 patients (15 with positive tests and 12 with normal exercise testing). In the remaining 56 young adults without multivessel involvement, positive tests were only observed in 15 patients and normal tests in 45. Thus, a sensitivity of 56%, specificity of 73%, positive predictive value of 50% and negative predictive value of 77% were found. When patients showed high risk exercise test criteria, the exercise test positive predictive value increased to 80%.


CONCLUSIONS
Due to the lower sensitivity of this test in young myocardial infarction survivors for detecting multivessel artery disease, we remark on the need for predischarge complementary tests such as isotopic, stress echocardiography or coronariography testing.
López-Candel
J
J
Servicio de Cardiología, Hospital General Universitario, Murcia.
Valdés
M
M
García-Alberola
A
A
López-Candel
E
E
Tortosa
J
J
de la Morena
G
G
Pinar
E
E
Pascual
D
D
Picó
F
F
Ruipérez
J A
JA
D000328:Adult; D000375:Aging / Q000502:physiology; D000790:Angiocardiography; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology; D005080:Exercise Test; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests