¿Es realmente útil la prueba de esfuerzo realizada después de un infarto de miocardio para mejorar el pronóstico de los pacientes? Argumentos a favor

Translated title of the contribution: Conventional stress test: Is it useful to improve patients prognosis post myocaedial infarction? Arguments in favour

José Azpitarte, Antonio Navarrete, Jesús Sánchez Ramos

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The evaluation of risk after myocardial infarction accomplishes two objectives: a) selecting patients with high-risk for coronary angiography and revascularization, and b) identifying low-risk patients to avoid unnecessary laboratory investigation and revascularization procedures. Currently, patients eligible for exercise test are those with no evidence of heart failure or angina, and with a preserved left ventricular function. Overall prognosis for such patients, especially if they were thrombolized, is very good. In this setting, in contrast to that pointed out in previous reports, the positive predictive value of exercise electrocardiography is very low (i.e., a patient with S-T depression has a probability of cardiac death in the ensuing year of only 4% vs 2% if the test is negative). This suggests that a routine postinfarction exercise test is inefficient from a prognostic point of view. However, a recent study has shown that thrombolized patients with a positive response to the exercise test, have a significantly lower rate of reinfarction and unstable angina when they undergo myocardial revascularization. Mortality rate, as it was low in the study population, was unchanged by the use of revascularization procedures. We conclude that, in spite of the limitations pointed out, there are at least two reasons to continue performing exercise tests in all uncomplicated infarctions: a) a negative test, due to its high negative predictive value for adverse events, reassures the patient and his family and prompts an early discharge, and b) some patients, despite an uncomplicated in-hospital evolution, have a «strong» positive response that suggests multivessel disease and a possible benefit from myocardial revascularization.

Original languageSpanish
Pages (from-to)533-540
Number of pages8
JournalRevista Espanola de Cardiologia
Volume51
Issue number7
StatePublished - Jul 7 1998
Externally publishedYes

Fingerprint

Exercise Test
Infarction
Myocardial Revascularization
Unstable Angina
Coronary Angiography
Left Ventricular Function
Electrocardiography
Heart Failure
Myocardial Infarction
Exercise
Mortality
Population

Keywords

  • Myocardial infarction
  • Myocardial recascularization
  • Treadmill test

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

¿Es realmente útil la prueba de esfuerzo realizada después de un infarto de miocardio para mejorar el pronóstico de los pacientes? Argumentos a favor. / Azpitarte, José; Navarrete, Antonio; Sánchez Ramos, Jesús.

In: Revista Espanola de Cardiologia, Vol. 51, No. 7, 07.07.1998, p. 533-540.

Research output: Contribution to journalArticle

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abstract = "The evaluation of risk after myocardial infarction accomplishes two objectives: a) selecting patients with high-risk for coronary angiography and revascularization, and b) identifying low-risk patients to avoid unnecessary laboratory investigation and revascularization procedures. Currently, patients eligible for exercise test are those with no evidence of heart failure or angina, and with a preserved left ventricular function. Overall prognosis for such patients, especially if they were thrombolized, is very good. In this setting, in contrast to that pointed out in previous reports, the positive predictive value of exercise electrocardiography is very low (i.e., a patient with S-T depression has a probability of cardiac death in the ensuing year of only 4{\%} vs 2{\%} if the test is negative). This suggests that a routine postinfarction exercise test is inefficient from a prognostic point of view. However, a recent study has shown that thrombolized patients with a positive response to the exercise test, have a significantly lower rate of reinfarction and unstable angina when they undergo myocardial revascularization. Mortality rate, as it was low in the study population, was unchanged by the use of revascularization procedures. We conclude that, in spite of the limitations pointed out, there are at least two reasons to continue performing exercise tests in all uncomplicated infarctions: a) a negative test, due to its high negative predictive value for adverse events, reassures the patient and his family and prompts an early discharge, and b) some patients, despite an uncomplicated in-hospital evolution, have a «strong» positive response that suggests multivessel disease and a possible benefit from myocardial revascularization.",
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