Angiographic identification of ejection fraction <30% or three-vessel disease was associated with a 22% mortality rate compared to 1% in patients with EF ≥30% and 1-2 vessel disease (p<0.001).
Cohort (n=179)
Do exercise testing, coronary angiography, and left ventriculography predict mortality and reinfarction in survivors of acute myocardial infarction?
Coronary angiography, left ventriculography, and exercise testing performed 6-8 weeks post-myocardial infarction effectively stratify patients into high and low risk groups for subsequent cardiac death and reinfarction.
Absolute Event Rate: 22% vs 1%
p-value: p=<0.001
This study provides data on a consecutive series of 179 survivors of acute myocardial infarction (MI) who had symptom-limited treadmill exercise testing, coronary angiography and left ventriculography within 6--8 weeks after infarction. No patient died. The prevalence of multivessel disease was higher in the symptomatic survivors (79%) (p less than 0.001). The prevalence of multivessel disease in inferior MI was 63% and in anterior MI 42% (p less than 0.001). Left ventricular impairment was more severe in anterior and preexisting MI than in inferior and nontransmural MI (p less than 0.005). During a mean follow-up of 28 months, 11 cardiac deaths and 12 reinfarctions occurred. The total mortality rate was 22% (10 of 46) in patients with an ejection fraction less than 30% or three-vessel disease and 1% (one of 133) in patients with an ejection fraction greater than or equal to 30% and one- or two-vessel disease (p less than 0.001). A group at high risk of mortality is thus identified by angiography. The total reinfarction rate was 9% (11 of 121) in patients with an exercise tolerance of less than 10 minutes (Bruce protocol) and 2% (one of 58) in patients with an exercise tolerance of 10 minutes or more (p less than 0.1). The 58 patients who had an exercise tolerance of 10 minutes or more had a very low risk for cardiac death or reinfarction.
Feyter et al. (1982) conducted a cohort in Acute myocardial infarction (MI) (n=179). Coronary angiography and left ventriculography (prognostic assessment) vs. Ejection fraction ≥30% and one- or two-vessel disease was evaluated on Total mortality (p=<0.001). Angiographic identification of ejection fraction <30% or three-vessel disease was associated with a 22% mortality rate compared to 1% in patients with EF ≥30% and 1-2 vessel disease (p<0.001).
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