Syed Zahed Rasheed, Abdus Samad.
Exercise Stress Test early after Acute Myocardial Infarction: Prognostic importance of clinical and exercise test variables on mortality.
Pak J Cardiol Jan ;10(4):87-94.

Acute myocardial infarction (AMI) carries high mortality during the years to follow. Patients who are at increased risk of dying during follow-up can be identified early after AMI. Exercise stress test (EST) is one of the most useful technique for this purpose. In this study patients were subjected to EST 3 to 6 days after uncomplicated AMI. The data were analyzed to see the predictive value of various clinical and exercise test variables for mortality during follow-up. A total of 105 patients who completed at least one year of follow-up were included in the final analysis. 93 (88.57 %) were male and 12 (11.43 %) were female patients. These patients were followed up for a mean period of 2.57 t 1.12 years. 21 (20.0%) patients died during this period (Group-A). 84 (80.0%) patients remain alive at the end of the study (Group-B). The mean age of patients in group-A was 53.86 f 7.59 years as compared to 47.51 t 8.40 years in group-B (p=0.002). In group-A 14 (66.66%) patients had anterior wall myocardial infarction and 7 (33.33%) had inferior wall myocardial infarction. While in group-B 35 (41.67%) patients had anterior wall infarction and 49 (58.33%) patients had inferior wall myocardial infarction (p=0.040). The other clinical variables i.e. distribution of patients in the two age groups (p=0.257); sex (p=0.490); smoking (p=0.512); and rate pressure product (p=0.132) did not show any significant difference between the two groups. The results showed response to exercise was significantly different in the two groups with respect to chest pain during exercise (p=0.010); ST-segment shift (p=0.05) and results of exercise test (p=0.027). The first year mortality was 5.7% with 83.33% patients having positive EST, and the second year mortality, was 7.07% with 85.71% patients having positive EST. The overall mortality was 20% during this period with 76.19% patients having positive EST. The relative risk of dying during follow-up was 2.80 times more with anterior wall myocardial infarction; 4.03 times more with chest pain during exercise; 3.33 times more with ST segment depression; 5.87 times more with ST segment elevation and 3.6 times more with positive EST. It is concluded age, anterior wall myocardial infarction, chest pain during exercise, ST-segment depression or elevation at peak exercise and a positive EST are important predictors of mortality after AMI.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com