Clinical characteristics of patients with exercise-induced ST-segment elevation without prior myocardial infarction.
BACKGROUND
Exercise-induced ST-segment elevation is a relatively uncommon problem and occurs more frequently in patients who have had a myocardial infarction. Data is limited on the characteristics of Taiwanese patients without prior myocardial infarction who develop exercise-induced ST-segment elevation.


RESULTS
Exercise-induced ST-segment elevation developed in 9 of 6,147 consecutive patients without myocardial infarction who underwent treadmill exercise testing at out institution over a 4-year period. The clinical and angiographic characteristics of these patients were studied. Angiographically normal coronary arteries with coronary vasospasm were found in 5 patients, hemodynamically significant coronary stenosis was found in 3 patients, and coexisting spasm in angiographically normal coronary arteries combined with hemodynamically significant coronary stenosis in the different vessel was found in 1 patient. During a median follow-up of 71 months, 2 patients with coronary vasospasm developed recurrent angina after self-discontinuation of calcium antagonists and 2 patients (1 with coronary vasospasm and 1 with hemodynamically significant coronary stenosis) died of cardiac causes before arrival at the emergency department.


CONCLUSIONS
Coronary vasospasm was a more common underlying pathology of exercise-induced ST-segment elevation in this Taiwanese cohort. Coronary angiography +/- intracoronary ergonovine provocation testing is necessary in these patients to identify the underlying pathology and appropriate treatment.
Hung
Ming-Jui
MJ
Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Taiwan. miran888@ms61.hinet.net
Hung
Ming-Yow
MY
Cheng
Chi-Wen
CW
Yang
Ning-I
NI
Cherng
Wen-Jin
WJ
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D015444:Exercise; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects / Q000503:physiopathology*; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008755:Methylergonovine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*
D008755:Methylergonovine