Prognostic value of exercise radionucide angiography in low risk acute myocardial infarction survivors

Abstract

Patients with an uneventful course during hospital stay, which represent from 30 to 50% of all myocardial infarction survivors, still have an incidence of new coronary events up to 7% during the first year of follow-up. To assess the value of radionuclide angiography in predicting new coronary events in this low risk population, 93 patients without evidence of left ventricular failure or recurrent postinfarction angina underwent rest and exercise radionuclide angiography and treadmill exercise testing before hospital discharge. During follow-up (16 +/- 5 months, range 12 to 32) 14 patients developed new coronary events: two patients died, four had a new myocardial infarction and the remaining eight had unstable angina. There were no differences regarding clinical variables, the results of the exercise test and the resting ejection fraction, between patients with or without new coronary events; however, patients without events during follow-up exercised longer during both exercise treadmill test and exercise radionuclide angiography. Resting end-diastolic and end-systolic volume indexes were higher in patients presenting coronary events (122 +/- 50 vs 92 +/- 32 ml.m-2, P < 0.05, 69 +/- 47 vs 47 +/- 26 ml.m-2, P < 0.05). These patients also had a higher incidence of wall motion abnormalities in more than one area (64 vs 28%, P < 0.02). During exercise, ejection fraction increased significantly in patients with an uneventful outcome (49 +/- 13 to 56 +/- 14%, P < 0.01), while it did not change in their counterparts (46 +/- 14 to 45 +/- 14%, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

“…Assessment of LV function after STEMI has been shown to be one of the most accurate predictors of future cardiac events in both the prereperfusion (1129) and the reperfusion (1130,1131) eras. Multiple techniques for assessing LV function of patients after STEMI have important prognostic value.…”

ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction:Executive Summary

“…Assessment of LV function after AMI has been demonstrated to be one of the most accurate predictors of future cardiac events in the risk stratification of patients with AMI in both the prereperfusion613 and the reperfusion eras (614,615). Multiple techniques for assessing LV function of patients after infarction have been shown to have important prognostic value and include such basic principles as clinical estimates based on patients' symptoms (eg, exertional dyspnea, functional status), physical findings (eg, rales, elevated jugular venous pressure, cardiomegaly, S 3 gallop), exercise duration (treadmill time) and measurement of ejection fraction by contrast ventriculography, radionuclide ventriculography, and 2-dimensional echocardiography.…”

Diagnostic and Prognostic Impact of Nuclear Cardiology in the Management of Acute Coronary Syndromes and Acute Myocardial Infarction

“…Rest LVEF identifies patients at high risk for death (9, 20–22). However, the presence of exercise‐induced ischaemia detected by RNA can further improve risk stratification (26–30) independent of whether the patient has single or multivessel disease (29). This is also true for patients receiving thrombolytic therapy, in whom exercise‐induced ischaemic LV dysfunction is frequently observed.…”