Author + information
- Received October 22, 1990
- Revision received April 2, 1991
- Accepted May 21, 1991
- Published online November 1, 1991.
- Jaume Candell-Riera, MDa,∗,
- Gaietà Permanyer-Miralda, MDa,
- Joan Castell, MDa,
- Andreu Rius-Daví, MDa,
- Enric Domingo, MDa,
- Empar Álvarez-Auñón, MDa,
- Montserrat Olona, MDb,
- Josep Rosselló, MDb,
- Domènec Ortega, MDa,
- Francesc M. Domènech-Torné, MDa and
- Jordi Soler-Soler, MDa
- ↵∗Address for reprints: Jaume Candell-Reira, MD, Servei de Cardiologia Hospital General Vall d'Hebron, Pg, Vall d'Hebron s/n, 08035 Barcelona, Spain.
To evaluate the prognostic role of combined cardiac studies (submaximal exercise test, thallium-201 scintigraphy, radionuclide exercise ventriculography, two-dimensional echocardiography, Holter monitoring and cardiac catheterization) in patients with a first acute myocardial infarction without complications during hospital admission, 115 consecutive patients aged <65 years were prospectively evaluated. The studies were carried out before hospital discharge and the patients were then clinically followed up for 12 months.
During the follow-up period, 69 patients (60%) developed complications, which were severe in 23 (20%). Half of all complications and 70% of severe complications developed during the 1st follow-up month. Logistic regression analysis disclosed that the combination of studies with the highest predictive power for complications (probability of complications 99%) and severe complications (probability of severe complications 95%) was the association of exercise test + thallium-201 + echocardiogram.
Four decision models (exercise test + echocardiography, exercise test + radionuclide ventriculography, thallium-201 scintigraphy + echocardiography, thallium-201 scintigraphy + radionuclide ventriculography) allowed the stratification of all patients in a particular risk category (high, intermediate or low). The best decision model was the association of thallium-201 scintigraphy + radionuclide ventriculography (probability of complications if both tests were positive 84%; probability of absence of severe complications if both tests were negative 88%), but there were no significant differences with the other models.
Any association of a test detecting residual ischemia or functional capacity, or both (exercise test or thallium-201) and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in significant prognostic information in patients with an uncomplicated first acute myocardial infarction. Additional cardiac catheterization does not improve the predictive power of noninvasive studies, which should ideally be performed before hospital discharge because most complications develop during the 1st follow-up month.
- Received October 22, 1990.
- Revision received April 2, 1991.
- Accepted May 21, 1991.