Predicting severe ischemic events after uncomplicated myocardial infarction by exercise testing and rest and exercise radionuclide ventriculography.
BACKGROUND
In 183 patients with uncomplicated myocardial infarction, exercise-induced angina, ST segment depression, decrease in ejection fraction, or inadequate increase in systolic blood pressure and low exercise tolerance were significantly associated with 4-year incidence of hard ischemic events.


RESULTS
Only the onset of both ST segment depression and a decrease in left ventricular ejection fraction with exercise was an independent predictor. ST segment depression and decrease in left ventricular ejection fraction had low sensitivity (61% and 70%) and specificity (56% and 51%) for hard ischemic events, but specificity increased to 78% when both were present. During medical therapy, 22 of 53 patients with both ST segment depression and a decrease in left ventricular ejection fraction with exercise had an ischemic event (i.e., 48.1% 4-year probability on Kaplan-Meier analysis vs 19.2% in the remaining 130 patients [p < 0.0005]).


CONCLUSIONS
Even if no single variable, derived from exercise testing, is a highly sensitive and specific predictor, specificity increases to a clinically relevant level by combining ST segment depression and a decrease in left ventricular ejection fraction with exercise, and in this way patients with recent infarction may be selected for coronary arteriography.
Mazzotta
G
G
Divisione di Cardiologia, E.O. Ospedali Galliera, Epidemiologia Clinica e Sperimentazioni Controllate, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
Camerini
A
A
Scopinarô
G
G
Villavecchiâ
G
G
Lionetto
R
R
Vecchio
C
C
D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D011379:Prognosis; D015635:Radionuclide Ventriculography; D013318:Stroke Volume