Copyright © 1993 by the European Society of Cardiology.
© 1993 The European Society of Cardiology
Prognostic value of exercise radionucide angiography in low risk acute myocardial infarction survivors
Cardiology, Hospital Clinic Barcelona, Spain
*Nuclear Departments, Hospital Clinic Barcelona, Spain
Received 13 December 1991; revised 21 August 1992; .
Correspondence: Dr Eulalia Roig, Cardiology Section, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain
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–1 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). Thus, the proportion of patients in whom the ejection fraction decreased > 5% during exercise was higher among patients developing new coronary events during follow-up (43 vs 10%, P < 0.01). There were no differences regarding exercise ventricular volumes.
Multivariate analysis, using data from the clinical course and resting radionuclide angiography, identified presence of extensive (> one area) regional wall motion abnormalities (P <0.01) and end-diastolic volume index (P <0.03) as independent predictors of prognosis. When data from exercise testing and exercise radionuclide angiography were added, a decrease in exercise ejection fraction > 5% (P < 0.005) and end-systolic volume index at rest (P <005) were identified as predictors of new coronary events. Comparison of sensitivity and specificity of each regression equation, using ROC curves, also indicated that exercise radionuclide angiography added information to rest variables.
In conclusion, rest and exercise radionuclide angiography are helpful in evaluating the prognosis in patients with an uneventful course after myocardial infarction. In this low risk group, exercise radionuclide angiography showed better prognostic value than the exercise test.
Key Words: Low risk myocardial infarction survivors • radionuclide angiography
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