Abstract

The prognostic value of symptom-limited treadmill exercise electrocardiography, exercise thallium myocardial perfusion scintigraphy and rest and exercise radionuclide ventriculography was compared in 117 men, aged 54 +/- 9 years, tested 3 weeks after a clinically uncomplicated acute myocardial infarction (MI). During a mean follow-up period of 11.6 months, 8 men experienced hard medical events (cardiac death, nonfatal ventricular fibrillation or recurrent MI) and 14 were hospitalized for unstable angina pectoris, congestive heart failure or coronary bypass surgery. By multivariate analysis, peak treadmill work load and the change in left ventricular ejection fraction (EF) during exercise were significant predictors of hard medical events; these 2 risk factors and recurrent ischemic chest pain in the coronary care unit were also significantly predictive for combined events. A peak treadmill work load of 4 METs or less or a decrease in EF of 5 or more below the value at rest during submaximal effort distinguished 22 high-risk patients from 89 low-risk patients. The rate of hard medical events within 12 months was 23, vs 2 in the high- and low-risk patient subsets, respectively. Thus, in patients who underwent evaluation 3 weeks after a clinically uncomplicated MI; exercise radionuclide ventriculography contributed independent prognostic information to that provided by symptom-limited treadmill testing and was superior to exercise thallium scintigraphy for this purpose. Verf.-Referat