Incidence and Prognostic Significance of Symptomatic and Asymptomatic Exercise-Induced Ischemia in Patients with Recent Myocardial Infarction

Abstract

To determine the incidence and the significance of anginal chest pain during abnormal exercise testing (⇓S-T ≧ 0.1 mV) in patients with recent myocardial infarction we reviewed a series of 353 patients who underwent maximal bicycle exercise stress 4–8 weeks following acute myocardial infarction. Of the 353 patients, 26 had ischemic ECG changes and chest pain (group A); 85 patients had ischemic ECG changes but no chest pain (group B). The two groups differ significantly only in the frequency of a history of typical angina pectoris more than 6 months prior to acute myocardial infarction (group A 42.3% vs. group B 15.2%, p < 0.01). Typical chest pain is more frequent in anterior versus inferior myocardial infarction (50 vs. 14.4%, p < 0.001). The patients were followed up for 28.8 ± 8.7 months with clinical and exercise testing controls. The incidence of exertional angina during the follow-up was significantly more frequent in group A patients than in group B patients (80.7 vs. 24.7%, p < 0.001). Unstable angina pectoris was more frequent in group A (34.6 vs. 11.8%, p < 0.01). There was no statistically significant difference in mortality (group A 3.8% vs. group B 5.9%) and cardiac events (group A 3.8% vs. group B 5.9%) between the two groups. Thus, we concluded that the occurrence of anginal pain associated with S-T segment depression during exercise testing does not increase the prognostic risk.

Exercise‐induced symptomatic ischaemia predicts a poor long‐term prognosis after acute myocardial infarction

“…Much controversy persists regarding the usefulness of using exercise‐induced symptomatic myocardial ischaemia as a parameter for risk stratification following AMI [10–16]. Opasich et al .…”

“…Opasich et al . [10] studied 353 patients who underwent maximal bicycle exercise stress testing 4–8 weeks following AMI. They concluded that the occurrence of angina pectoris associated with ST‐segment depression did not increase the risk of subsequent cardiac events during a mean follow‐up of 29 ± 9 months.…”

“…Despite extensive studies, the prognostic significance of residual ischaemia in the postinfarction patient remains controversial [3–9]. The suggestion that the association of exercise‐induced myocardial ischaemia and anginal pain might define a subgroup of post‐AMI patients with a higher risk for subsequent cardiac events has been raised but not corroborated during short‐term follow‐up studies [10–15]. The purpose of our study was to evaluate prospectively the long‐term prognostic significance of symptomatic myocardial ischaemia as provoked during exercise testing performed 3 weeks after AMI.…”

Exercise-Induced ST Depression as a Prognostic Indicator of Cardiac Morbidity in Thrombolytic-Treated Post-Myocardial Infarction Patients with Silent Ischemia

“…signs of ischemia without angina pectoris, has been questioned [1][2][3][4][5][6]. Reports addressing this subject have especially focussed on the difference in future cardiac risk among patients with symptomatic angina pectoris compared to patients without symptoms [2,4,[7][8][9][10].…”