SUBMAXIMAL EARLY EXERCISE TEST COMPARED TO CLINICAL FINDINGS FOR EVALUATION OF SHORT-TERM AND LONG-TERM PROGNOSIS AFTER THE FIRST MYOCARDIAL-INFARCTION

Clinical and ergometric data were derived from 1098 consecutive exerci se tests in patients with a first acute myocardial infarction between 1974-1983. In 1992 a follow-up was performed in order to analyse the i mportance of a submaximal early exercise test, in combination with cli nical data, for the prediction of short- and long-term prognosis of ca rdiovascular death. The relative value of 20 clinical variables, inclu ding medical history, markers of infarction size, medication etc., and 28 variables at exercise test were studied. Univariate, multivariate and survival analysis, for estimation of prognosis and independent pre diction of cardiovascular death was used. Independent clinical risk fa ctors for cardiovascular death were (1) Within 1 year: relative heart volume (ml.m(-2) body surface area) on chest X-ray. (2) Long-term mort ality: maximum heart rate and relative heart volume. diabetes. age and digitalis medication. Independent exercise risk factors were: (1) Wit hin 1 year: heart rate, ventricular arrhythmia and ST depression great er than or equal to 1 mm before exercise, diastolic blood pressure at maximum exercise and target heart rate. (2) Long-term mortality: angin a pectoris and/or ST depression greater than or equal to 1 mm at maxim um exercise. In subgroups of patients with clinical risk factors, mort ality risk increased if there were signs of angina pectoris and/or ST depression greater than or equal to 1 mm during exercise. The risk inc reased 100% in diabetics, 91% with age >70 years, 58% with relative he art volume greater than or equal to 500 ml. m(-2) body surface area, 4 2% with heart rate greater than or equal to 100 at admission, and 34% with digitalis medication. No increase was found in the subgroup of pa tients without clinical risk factors. Thus, submaximal early exercise stress testing provides important information for short- and lone-term prognosis in patients after the first acute myocardial infarction com pared to clinical evaluation alone.