CONVENTIONAL STRESS TEST - IS IT USEFUL T O IMPROVE PATIENTS PROGNOSIS POST MYOCARDIAL-INFARCTION - ARGUMENTS IN FAVOR

The evaluation of risk after myocardial infarction accomplishes two ob jectives: a) selecting patients with high-risk for coronary angiograph y and revascularization, and b) identifying low-risk patients to avoid unnecessary laboratory investigation and revascularization procedures . Currently, patients eligible for exercise test are those with no evi dence of heart failure or angina, and with a preserved left ventricula r function. Overall prognosis for such patients, especially if they we re thrombolized, is very good. In this setting, in contrast to that po inted out in previous reports, the positive predictive value of exerci se electrocardiography is very low (i.e., a patient with S-T depressio n has a probability of cardiac death in the ensuing year of only 4% vs 2% if the test is negative). This suggests that a routine postinfarct ion exercise test is inefficient from a prognostic point of view. Howe ver, a recent study has shown that thrombolized patients with a positi ve response to the exercise test, have a significantly lower rate of r einfarction and unstable angina when they undergo myocardial revascula rization. Mortality rate, as it was low in the study population, was u nchanged by the use of revascularization procedures. We conclude that, in spite of the Limitations pointed out, there are at least two reaso ns to continue performing exercise tests in all uncomplicated infarcti ons: a) a negative test, due to its high negative predictive value for adverse events, reassures the patient and his family and prompts an e arly discharge, and b) some patients, despite an uncomplicated in-hosp ital evolution, have a ''strong'' positive response that suggests mult ivessel disease and a possible benefit from myocardial revascularizati on.