Key result
The Stress-Recovery Index was superior to conventional ST depression in identifying multivessel disease in post-MI patients on beta-blocker therapy, demonstrating higher sensitivity (P > 0.001).
Why the study?
Does beta-blocker therapy affect the diagnostic accuracy of Stress-Recovery Index (SRI) versus ST depression for identifying multivessel disease in post-MI patients?
RCT (n=75)
random sequence
Does beta-blocker therapy affect the diagnostic accuracy of Stress-Recovery Index (SRI) versus ST depression for identifying multivessel disease in post-MI patients?
The Stress-Recovery Index (SRI) is superior to conventional ST depression for identifying complex coronary anatomy in post-MI patients, particularly when they are on beta-blocker therapy.
Supports prioritizing SRI over ST depression to identify multivessel disease in beta-blocked post-MI patients; extends diagnostic comparisons to this therapy context.
Objective: The aim of this study was to evaluate the influence of pharmacological therapy on the assessment of coronary anatomy by means of, respectively, conventional ST depression and comparative heart‐rate adjusted ST segment (ST/HR) analysis during exercise and recovery following acute Ml. Background: The withdrawal of therapy before stress testing is controversial. We previously demonstrated that a simple continuous variable (Stress‐Recovery Index [SRI] defined as the difference between the areas subtended to baseline and limited by ST trend against HR during exercise and recovery) can substantially improve the post‐MI identification of multivessel disease (MVD). Methods: Seventy‐five patients underwent maximal exercise ECG test on and off beta‐blockers with or without additional therapy, in random sequence, within 2 weeks of infarction. Coronary angiography was done within 1 month. The test was considered positive for increased risk of MVD in case of ST depression < 2 mm and, respectively, SRI > 5 mm × beats × min −1 , as previously suggested. Results: Off therapy, ST depression was positive in 33 and negative in 42 patients, while SRI was positive in 35 and negative in 40; on therapy, ST depression was positive in 21 and negative in 54 patients, while SRI was positive in 44 and negative in 31. Forty‐four subjects had MVD. The sensitivity and specificity of SRI were, respectively, increased and reduced by therapy, while an opposite effect was found on ST depression. SRI on therapy was more sensitive (P > 0.001) and less specific (P > 0.05) than ST depression and was the most sensitive parameter in identifying only 3‐vessel. Positive ST depression and negative SRI on therapy were associated, respectively, with the highest and lowest Gensini's score. Conclusions: The SRI is superior to ST depression in identifying complex coronary anatomy in post‐Ml patients, especially during beta‐blockade therapy. A.N.E. 1999;4(1):60–66
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Bigi et al. (1999) conducted an RCT in Postinfarction (acute myocardial infarction) (n=75). Maximal exercise ECG test on beta-blockers vs. Maximal exercise ECG test off beta-blockers was evaluated on Identification of multivessel disease (MVD) (p=> 0.001). The Stress-Recovery Index was superior to conventional ST depression in identifying multivessel disease in post-MI patients on beta-blocker therapy, demonstrating higher sensitivity (P > 0.001).
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