Evaluation of the prognosis after Q wave myocardial infarction: a comparison of non-invasive and invasive diagnostic strategies.

The predictive value of several diagnostic strategies after myocardial infa rction was assessed in 178 patients (mean age 55 +/- 9 years) treated medic ally after a primary Q wave myocardial infarction. Within 6 weeks of onset of symptoms the authors performed exercise stress test coupled with Thalliu m 201 scintigraphy, isotopic left ventriculography and conventional coronar y angiography with ventriculography. The average left ventricular ejection fraction was 45 +/- 12%. Two non-invasive diagnostic strategies with and wi thout results of scintigraphy and two invasive strategies with and without ventricular volumes were studied. The average follow-up period was 58 +/- 22 months. Sixteen cardiac deaths o ccurred. Multivariate Cox analysis showed that, in contrast to left ventricular volu mes, coronary angiography did not provide additional prognostic value compa red with the non-invasive model with Thallium scintigraphy and did not appe ar to be essential in terms of predictive value in this population. Moreove r, the size of reversible defect on Thallium scintigraphy was an independan t predictive factor of cardiac death and provided additional and independen t prognostic information in the non-invasive and invasive strategies. There fore, the reduction of residual ischaemia by coronary revascularisation cou ld improve the long-term prognosis after myocardial infarction.