| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
Department of Cardiology, London Chest Hospital.
OBJECTIVES--To evaluate the role of a treadmill stress test for identifying patients at risk of recurrent ischaemic events after acute myocardial infarction treated by thrombolysis. BACKGROUND--The natural history of myocardial infarction has changed with the introduction of thrombolytic treatment; there is a lower mortality but a higher incidence of recurrent thrombotic events (reinfarction, unstable angina). The treadmill stress continues to be recommended for risk stratification after acute myocardial infarction even though its value has never been formally reassessed in the thrombolytic era. METHODS--Prospective observational study in which 256 consecutive patients who presented with acute myocardial infarction treated by thrombolysis underwent an early treadmill stress test and were followed up for 10 (range 6-12) months. RESULTS--Recurrent ischaemic events occurred in 41 patients (unstable angina 15, reinfarction 21, death five) and a further 21 required revascularisation. Both ST depression at a low workload and low exercise tolerance (< 7 metabolic equivalents of the task (METS) were predictive of recurrent events, with respective hazard ratios of 1.93 (95% confidence interval (95% CI) 1.17-3.20; p < 0.01)) and 1.67 (95% CI 1.0-2.78; p < 0.05). These variables identified 50% and 70% of patients who subsequently sustained a recurrent ischaemic event, but the corresponding values for positive predictive accuracy were only 26% and 21%. Thus they are of limited value as a screening measure for identifying patients likely to benefit from invasive investigation and revascularisation. None of the other variables (ST elevation, haemodynamic responses, ventricular extrasystoles, angina) was significantly associated with recurrent ischaemic events. CONCLUSIONS--The treadmill stress test is of limited value for identifying patients at risk of recurrent ischaemic events after acute myocardial infarction treated by thrombolysis.
Relevant Article
This article has been cited by other articles:
|
|
 |
|
  A Desideri, P M Fioretti, L Cortigiani, G Trocino, C Astarita, D Gregori, J Bax, J Velasco, L Celegon, R Bigi, et al. Pre-discharge stress echocardiography and exercise ECG for risk stratification after uncomplicated acute myocardial infarction: results of the COSTAMI-II (cost of strategies after myocardial infarction) trial Heart, February 1, 2005; 91(2): 146 - 151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A A Awad-Elkarim, J P Bagger, C J Albers, J S Skinner, P C Adams, and R J C Hall A prospective study of long term prognosis in young myocardial infarction survivors: the prognostic value of angiography and exercise testing Heart, August 1, 2003; 89(8): 843 - 847. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Abboud, J. Hir, I. Eisen, A. Cohen, and W. Markiewicz Long-term Value of Exercise Testing After Acute Myocardial Infarction: Influence of Thrombolytic Therapy Chest, February 1, 2000; 117(2): 556 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Jensen-Urstad, B A Samad, F Bouvier, J Hulting, J Hojer, H Ruiz, and M Jensen-Urstad Prognostic value of symptom limited versus low level exercise stress test before discharge in patients with myocardial infarction treated with thrombolytics Heart, August 1, 1999; 82(2): 199 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Previtali, R. Fetiveau, L. Lanzarini, C. Cavalotti, and C. Klersy Prognostic value of myocardial viability and ischemia detected by dobutamine stress echocardiography early after acute myocardial infarction treated with thrombolysis J. Am. Coll. Cardiol., August 1, 1998; 32(2): 380 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Basu, R. Senior, U. Raval, and A. Lahiri Superiority of Nitrate-Enhanced 201Tl Over Conventional Redistribution 201Tl Imaging for Prognostic Evaluation After Myocardial Infarction and Thrombolysis Circulation, November 4, 1997; 96(9): 2932 - 2937. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. Basu, R. Senior, C. Dore, and A. Lahiri Value of thallium-201 imaging in detecting adverse cardiac events after myocardial infarction and thrombolysis: a follow up of 100 consecutive patients BMJ, October 5, 1996; 313(7061): 844 - 848. [Abstract] [Full Text]
|
|
|
|
|
|
B. Pitt Evaluation of the Postinfarct Patient Circulation, March 15, 1995; 91(6): 1855 - 1860. [Full Text]
|
|
|
|
|
|
A D Flapan Fortnightly Review: Management of patients after their first myocardial infarction BMJ, October 29, 1994; 309(6962): 1129 - 1134. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
