Key result
Positive post-MI exercise stress test linked to ~6.5-fold higher mortality versus negative test.
Why the study?
Does a positive exercise stress test (ST-depression ≥1 mm) predict increased mortality in patients who survived an acute myocardial infarction with complications?
Cohort (n=154)
No
Does a positive exercise stress test (ST-depression ≥1 mm) predict increased mortality in patients who survived an acute myocardial infarction with complications?
Absolute Event Rate: 33.3% vs 5.1%
A positive exercise stress test 4 to 6 weeks after a complicated acute myocardial infarction identifies a high-risk subgroup with significantly higher mortality, warranting more intensive management.
We prospectively selected 154 patients who had survived acute myocardial infarction with electrical and/or mechanical complications to undergo an exercise stress test, four to six weeks after discharge from the Coronary Care Unit, Royal Melbourne Hospital. The patients exercised on a bicycle ergometer until they were unable to continue or had reached 70% of their predicted maximum heart rate for their age. Eighteen (11.7%) patients exhibited flat ST-depression of 1 mm or more on exercise. Six of these 18 patients later died (33.3%). Only seven (5.1%) of the 136 patients who exhibited no electrocardiographic change died during follow-up. We conclude that patients recording positive exercise stress test results after acute myocardial infarction, have a poorer prognosis and therefore should be considered for more intensive medical or surgical treatment.
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Srinivasan et al. (1981) conducted a cohort in Acute myocardial infarction (n=154). Positive exercise stress test (flat ST-depression ≥1 mm) vs. No electrocardiographic change on exercise stress test was evaluated on Death. A positive exercise stress test (≥1 mm ST-depression) 4-6 weeks post-myocardial infarction was associated with higher mortality compared to no electrocardiographic change (33.3% vs 5.1%).
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