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European Heart Journal 1992 13(2):201-206;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Functional evaluation 10 days and 3 weeks after acute myocardial infarction: comparative significance and prognostic value

B. CARÙ, M. BOSSI{dagger}, R. BONELLI*, E. COLOMBO*, R. PEDRETTI*, F. SANTORO*, C. ANZÀ*, F. MASLOWSKY* and A. LAPORTA*

{dagger}Divisione di Cardiologia, Ospedale di Saronno Saronno Italy
*Divisione di Cardiologia, Centro Medico di Tradate, Fondazione Clinica del Lavoro IRCCS, Tradate, Italy

Received 30 July 1990; revised 7 November 1990; accepted 8 January 1991.

Correspondence: Bruno Carù MD, Centro Medico di Tradate, Fondazione Clinica del Lavoro, IRCCS, Via Roncaccio 16, 21049 Tradate, Italy

Abstract

Early functional evaluation after non-complicated acute myocardial infarction (AMI) is widely recommended because of its prognostic value in the short term. In fact it seems to have a prognostic value within 15–20 days of the AMI, but in this period the patient is particularly controlled and is often still hospitalized. To evaluate the real significance of an early functional evaluation within 10 days of the AMI (mean 8.6 days±1.2) as compared to an identical functional evaluation performed at 3 weeks after AMI (mean 20.16 days ± 5.38) 25 patients with uncomplicated myocardial infarction were studied. Significant statistical differences were found between the first (ET1) and second (ET2) functional evaluations: they concern the maximal heart rate reached (P <0.001), the maximal pressure-rate product (P < 0.05) the percentage increment of heart rate (P <0.01) and the total work performed (P <0.001). Agreement between ET1 and ET2 was found in 19 cases; 12 patients showed markers of ischaemia both at ET1 and ET2, while seven were free from ischaemia at both times. In six cases a disagreement between ET1 and ET2 was found: in particular, three cases had ischaemic ET1 and nonischaemic ET2; the reverse was seen in the other three. During follow-up (mean 215.4 days ± 85.5), the total number of new events (reinfarctions, angina or surgery) among the 25 patients was eight; none occurred within the first 30 days after the AMI. Our conclusion supports the idea that if the early functional evaluation is possible and safe post-M1, it has a limited value for the short term prognosis. Afunctional evaluation at 3 weeks is preferable.

Key Words: Myocardial infarction • early exercise test • late exercise test • prognosis


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