Prognostic Value of Exercise Testing, Coronary Angiography and Left Ventriculography 6–8 Weeks After Myocardial Infarction

This study provides data on a consecutive series of 179 survivors of acute myocardial infarction (MI) who had symptom-limited treadmill exercise testing, coronary angiography and left ventriculography within 6-8 weeks after infarction. No patient died. The prevalence of multivessel disease was higher in the symptomatic survivors (79%) (p < 0.001). The prevalence of multivessel disease in inferior MI was 63% and in anterior MI 42% (p < 0.001). Left ventricular impairment was more severe in anterior and preexisting MI than in inferior and nontransmural MI (p < 0.005).During a mean follow-up of 28 months, 11 cardiac deaths and 12 reinfarctions occurred. The total mortality rate was 22% (10 of 46) in patients with an ejection fraction < 30% or three-vessel dise'ase and 1% (one of 133) in patients with an ejection fraction &phis; 30% and one- or two-vessel disease (p < 0.001). A group at high risk of mortality is thus identified by angiography. The total reinfarction rate was 9% (11 of 121) in patients with an exercise tolerance of less than 10 minutes (Bruce protocol) and 2% (one of 58) in patients with an exercise tolerance of 10 minutes or more (p < 0.1). The 58 patients who had an exercise tolerance of 10 minutes or more had a very low risk for cardiac death' or reinfarction.