Intraindividual comparison of three stress tests during the early postinfarction period in stable patients with thrombolysis.
The intention of the study was to intraindividually compare the ischemic yield of three stress tests early after acute myocardial infarction. At a large community hospital 107 stable patients who survived acute transmural myocardial infarction after thrombolytic therapy followed by an individual optimized medical treatment, were prospectively investigated by three noninvasive stress tests. All patients received bicycle ergometry, 99mTc perfusion scintigraphy and stress-echocardiography within three weeks after the acute event. Each patient underwent diagnostic cardiac catheterization for determination of angiographic data. 99mTc perfusion scintigraphy had the highest rate of positive test results (61%), as compared to bicycle ergometry (32%), stress echocardiography (34%) and stress induced angina in any of the stress tests performed (40%). In 79% of the patients studied, at least one of four ischemic parameters was positive. The combination of bicycle ergometry, stress induced angina and 99mTc perfusion scintigraphy detected myocardial ischemia in 78% of the patients studied. Concordance of at least three positive parameters was seen in only 27%. Intraindividual comparison between positive and negative test results was inconclusive. Only stress-echocardiography versus stress-induced angina showed a moderate agreement (kappa = 0.44). Stress-induced angina was the only ischemic parameter which corresponded to the grade of the residual stenosis of the infarct related coronary artery (p < 0.01) and reduced left ventricular function (p < 0.005). These findings show, that concordance of three common stress tests in detecting myocardial ischemia anywhere in patients after acute transmural myocardial infarction and thrombolytic therapy is poor. Stress-echocardiography and stress inducible angina show a moderate agreement. Follow-up studies of these patients are currently performed to clarify prognostic significance and therapeutic consequences of positive test results in these patients.
Wagner
S
S
Department of Cardiology, Herzzentrum Ludwigshafen, Städtisches Klinikum Ludwigshafen, Germany.
Schuster
S
S
Zahn
R
R
Sattler
B
B
Hübner
C
C
Senges
J
J
D000787:Angina Pectoris; D017023:Coronary Angiography; D004280:Dobutamine / Q000627:therapeutic use; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005858:Germany; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D017202:Myocardial Ischemia; D015203:Reproducibility of Results; D017256:Technetium Tc 99m Sestamibi; D015912:Thrombolytic Therapy
D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi