STRATEGIES FOR PROGNOSTIC ASSESSMENT OF UNCOMPLICATED FIRST MYOCARDIAL-INFARCTION - 5-YEAR FOLLOW-UP-STUDY

Objectives. Our aim was to use noninvasive studies early after infarct ion to assess medium-term prognosis in patients with a first uncomplic ated myocardial infarction. Background. Although the use of early post infarction assessment to gauge short-term prognosis in myocardial infa rction is well established, there have been few comprehensive evaluati ons of noninvasive methods for assessing medium- and long-term prognos is. Methods. We prospectively studied 115 consecutive patients < 65 ye ars old with a first acute uncomplicated myocardial infarction to eval uate the prognostic role of predischarge cardiac studies. These includ ed submaximal exercise testing, thallium-201 scintigraphy, radionuclid e exercise ventriculography, two-dimensional echocardiography, ambulat ory electrocardiographic (Holter) monitoring and cardiac catheterizati on. All patients without complications were followed up greater than o r equal to 5 years. Results. During the follow-up period, 78 patients (68%) developed complications, which were severe in 37 (32%). Exercise thallium-201 scintigraphy yielded the highest percentage (77%) for co rrectly classified patients. It also had the highest predictive value for complications (97%) and severe complications (92%) when it was use d in association with exercise testing and radionuclide ventriculograp hy. The addition of cardiac catheterization did not improve on the pre dictive power of noninvasive studies. Four decision trees (exercise te sting + echocardiography, exercise testing + radionuclide ventriculogr aphy, thallium-201 + echocardiography, thallium-201 + radionuclide ven triculography) allowed stratification of all patients in a high, inter mediate or low risk category. The combination of thallium-201 scintigr aphy and radionuclide ventriculography yielded the best results (90% p redictive value for complications if the outcome of both tests was pos itive), but there were no significant differences with the other model s. Conclusions. Any combination of a test detecting residual ischemia or functional capacity, or both (exercise testing or thallium-201 scin tigraphy), and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in useful prognostic inform ation in patients with an uncomplicated first acute myocardial infarct ion.