Author + information
- Received December 12, 1988
- Revision received February 21, 1989
- Accepted March 15, 1989
- Published online August 1, 1989.
- Jacob Klein, MD∗,
- Victor F. Froelicher, MD, FACC∗∗,
- Robert Detrano, MD, PhD∗,
- Paul Dubach, MD† and
- Ray Yen, MD∗
- ↵∗Address for reprints: Victor F. Froelicher, MD, Cardiology Section (111C), Long Beach Veterans Administration Medical Center, 5901 East Seventh Street, Long Beach, CA 90822.
The failure of exercise-induced ST segment depression to consistently predict prognosis in patients after myocardial infarction could be a result of population differences and the rest electrocardiogram (ECG). These hypotheses were tested by studying 198 veterans who survived a myocardial infarction, underwent a submaximal predischarge treadmill exercise test and were followed up for cardiac events for 2 years. During the 2 years, 29 deaths, 19 reinfarctions and 28 revascularization procedures were documented. The prevalence of death or reinfarction was two times higher in patients who had exercise-induced ST depression than in patients who did not. However, in the 55 patients without Q waves, the risk increased to 11 times for an abnormal ST response.
These findings suggest that exercise-induced ST depression only predicts high risk in patients after myocardial infarction whose ECG at rest does not exhibit Q waves and that differences in the prevalence of rest ECG patterns are the most likely explanation for the failure of agreement among prior studies.
- Received December 12, 1988.
- Revision received February 21, 1989.
- Accepted March 15, 1989.