IS PREDISCHARGE EXERCISE TESTING STILL US EFUL IN YOUNG SURVIVORS AFTER MYOCARDIAL-INFARCTION IN DETECTION OF MULTIVESSEL CORONARY-DISEASE

Background and objectives. Conventional exercise testing before hospit al discharge is the most useful proccedure in order to estimate postin farction prognosis and in detecting multivessel coronary disease which is associated with a poor longterm prognosis. There are no bibliograp hic reports about it in younger myocardial infarction survivors. The a im of the study was to evaluate sensitivity, specificity and predictiv e value of symptoms Limited maximal exercise testing for multivessel d isease diagnosis in young patients after myocardial infarction. Method s. Myocardial infarction survivors until the age of 40 performed sympt oms limited maximal exercise testing and had a coronary arteriography before hospital discharge. Results. A total of 100 consecutive patient s were included, although in only 83 of them exercise tests and corona riographic studies were done. In this group, multivessel disease was c onfirmed in 27 patients (15 with positive tests and 12 with normal exe rcise testing). In the remaining 56 young adults without multivessel i nvolvement, positive tests were only observed in 15 patients and norma l tests in 45. Thus, a sensitivity of 56%, specificity of 73%, positiv e predictive value of 50% and negative predictive value of 77% were fo und. When patients showed high risk exercise test criteria, the exerci se test positive predictive value increased to 80%. Conclusions. Due t o the lower sensitivity of this test in young myocardial infarction su rvivors for detecting multivessel artery disease, we remark on the nee d for predischarge complementary tests such as isotopic, stress echoca rdiography or coronariography testing.