PREDICTING SEVERE ISCHEMIC EVENTS AFTER UNCOMPLICATED MYOCARDIAL-INFARCTION BY EXERCISE TESTING AND REST AND EXERCISE RADIONUCLIDE VENTRICULOGRAPHY

Background. In 183 patients with uncomplicated myocardial infarction, exercise-induced angina, ST segment depression, decrease in ejection f raction, or inadequate increase in systolic blood pressure and low exe rcise tolerance were significantly associated with 4-year incidence of hard ischemic events. Methods and Results. Only the onset of both ST segment depression and a decrease in left ventricular ejection fractio n with exercise was an independent predictor. ST segment depression an d decrease in left ventricular ejection fraction had low sensitivity ( 61% and 70%) and specificity (56% and 51%) for hard ischemic events, b ut specificity increased to 78% when both were present. During medical therapy, 22 of 53 patients with both ST segment depression and a decr ease in left ventricular ejection fraction with exercise had an ischem ic event (i.e., 48.1% 4-year probability on Kaplan-Meier analysis vs 1 9.2% in the remaining 130 patients [p < 0.0005]). Conclusions. Even if no single variable, derived from exercise testing, is a highly sensit ive and specific predictor, specificity increases to a clinically rele vant level by combining ST segment depression and a decrease in left v entricular ejection fraction with exercise, and in this way patients w ith recent infarction may be selected for coronary arteriography.