ISCHEMIC EPISODES DETECTED BY EARLY EXERCISE TEST AND HOLTER MONITORING AFTER MYOCARDIAL-INFARCTION - WHICH ARE OF MOST PROGNOSTIC VALUE

Background The aim of this study was to assess the significance of ST- segment depressions (ST-SD) detected during exercise test or Holter mo nitoring and to determine which parameters of ST-SD are the most impor tant prognostic factors in patients after myocardial infarction. Metho ds The study group consisted of 164 patients (126 men and 38 women) wh o survived their first uncomplicated myocardial infarction. Twenty-fou r-hour Holter monitoring on day 10 (+/-2) after infarction and a tread mill exercise test 1 or 2 days later were performed. The following par ameters of ST-SD were taken into consideration: amplitude, localizatio n according to the area of infarction and presence or absence of conco mitant angina. Patients were observed for 24 months to assess the occu rrence of new cardiac events. Results In 78 patients (group I) ST-SD w ere detected in both Holter monitoring and the exercise test, and in 3 2 patients (group II) in the exercise test only. Fifty-four patients ( group III) were without ST-SD. During follow-up there were 83 cardiac events in group I, 24 in group II and 16 in group III (P < 0.01, group I Versus II; P < 0.0001, group I versus III; P < 0.05, group II versu s III). In multivariate analysis the presence of ST-SD during Holter m onitoring or the exercise test, or both, appeared to be of most progno stic significance (P < 0.0001). The number of new cardiac events was s ignificantly higher in patients with painful ST-SD greater than 3 mm, detected outside the area of infarction (distant ischaemia). Conclusio ns This study shows a significant prognostic value of early post-infar ction ischaemia detected by Holter monitoring and an exercise test. Di stant, painful ST-SD greater than 3 mm were more powerful determinants of poor prognosis than others. Electrode placement during Holter moni toring appears to be very important, particularly in post-infarction p atients.