Author + information
- Received September 19, 1988
- Revision received December 19, 1988
- Accepted January 25, 1989
- Published online July 1, 1989.
- Ronald J. Krone, MD FACC1,∗,
- Edward M. Dwyer Jr., MD FACC†,
- Henry Greenberg, MD FACC†,
- J.Philip Miller, AB‡,
- John A. Gillespie, MD FACC§,
- Multicenter Post-Infarction Research Group
- ↵1Address for reprints: Ronald J Krone, MD, Cardiology Division, The Jewish Hospital at Washington University, 216 South Kingshighway, St. Louis, Missouri 63110
Risk stratification using clinical and historical variables plus early low level exercise testing was performed in 141 patients with a first non-Q wave myocardial infarction. The 111 patients who performed the exercise test had a 3.6% cardiac mortality rate in the first year compared with 13.3% in the 30 patients who could not exercise (p = 0.063), and a 1 year incidence rate of recurrent cardiac events (cardiac death or recurrent nonfatal myocardial infarction) of 10.8% compared with 23.3% (p = 0.127). Patients who developed ischemia (ST depression or angina) during the test had an increased incidence of cardiac events in the year after the infarction (odds ratio >3, p < 0.05).
When patients were subgrouped by the presence or absence of pulmonary congestion, the discriminatory value of the exercise test was seen to reside primarily in the cohort with pulmonary congestion. For example, ST depression during exercise in this group identified patients with a 71 % incidence of cardiac events in the year after the infarction compared with 5.3% for those without ST depression (odds ratio 45, p = 0.002). In the patients without pulmonary congestion, the exercise test had no discriminatory value.
It is concluded that early low level exercise testing has a limited role after an uncomplicated non-Q wave infarction, but is useful in patients with clinical markers of higher risk.
☆ This study was supported in part by Grant HL-22982 from the National Institutes of Health, Bethesda, Maryland and by funds from the Gebbie Foundation, Jamestown, New York: Merck Sharp and Dohme, West Point, Pennsylvania and the Flinn Foundation, Phoenix, Arizona. It was presented in part at the 60th Annual Scientific Sessions of the American Heart Association, Anaheim, California. November 16 to 18. 1987
- Received September 19, 1988.
- Revision received December 19, 1988.
- Accepted January 25, 1989.