Prognostic Significance of Maximal Exercise Testing After Uncomplicated Myocardial Infarction

To investigate the prognostic s ignificance of maximal exerc ise tes ting two months after uncomplicated myocardial infaretion (Ml). 506 patients (462 men, 44 women, mean age 5 ı .7±9.4, 246 anterior and 242 inferior Ml) were followed up for one year. The exercise test criteria for ischemia were typical angina pectoris and or ST depression of 1 mm. Exercise time less than 6 minules and exercise-induced systolic blood pressure (SBP) increase Jess than 30 mmHg were other parameters for high risk. Cardiac events (CE) were defined as cardiac death, reinfarction, unstable angina pectoris, a coronary angioplasty or aorto-coronary by-pass surgery. During follow-up 9 patients (1.8 %) died and 92 (18.2 %) had a cardiac event. The positive predictive va1ues of ECG ischemia, exercise duration, and ASBP for death were found to be 2% 4% and 3%, respectively for coronary events, the positive predictive value of ECG ischemia, exercise duration and ~SBP were 27%, 34% and 23%, respectively. The negative predictive values of the same parameters were found to be 99% and 89%, 99% and 87%, and 99% and 87%, respectively. When all of the parameters were considered together, the positive and negative predictive values for death and coronary events were found to be 10% and 81%,99% and 98%, respectively. It is concluded that, after an uncomplicated myocardia1 infarction, patients without ischemia and with a good exercise capacity and systolic blood pressure response to exercise need not undergo routine coronary angiography. Key words: Myocardial infarction, exercise test, prognosisTo investigate the prognostic s ignificance of maximal exerc ise tes ting two months after uncomplicated myocardial infaretion (Ml). 506 patients (462 men, 44 women, mean age 5 ı .7±9.4, 246 anterior and 242 inferior Ml) were followed up for one year. The exercise test criteria for ischemia were typical angina pectoris and or ST depression of 1 mm. Exercise time less than 6 minules and exercise-induced systolic blood pressure (SBP) increase Jess than 30 mmHg were other parameters for high risk. Cardiac events (CE) were defined as cardiac death, reinfarction, unstable angina pectoris, a coronary angioplasty or aorto-coronary by-pass 133 Türk Kardiyol Dem Arş 1999:27: 132-135 surgery. During follow-up 9 patients (1.8 %) died and 92 (18.2 %) had a cardiac event. The positive predictive va1ues of ECG ischemia, exercise duration, and ASBP for death were found to be 2% 4% and 3%, respectively for coronary events, the positive predictive value of ECG ischemia, exercise duration and ~SBP were 27%, 34% and 23%, respectively. The negative predictive values of the same parameters were found to be 99% and 89%, 99% and 87%, and 99% and 87%, respectively. When all of the parameters were considered together, the positive and negative predictive values for death and coronary events were found to be 10% and 81%,99% and 98%, respectively. It is concluded that, after an uncomplicated myocardia1 infarction, patients without ischemia and with a good exercise capacity and systolic blood pressure response to exercise need not undergo routine coronary angiography.