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European Heart Journal 1993 14(4):499-504;
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Seven-year prognostic value of the electrocardiogram at rest and an exercise test in patients admitted for, but without, confirmed myocardial infarction

P. FRUERGAARD*,, J. LAUNBJERG*, H. LOFT JACOBSEN{dagger} and J. KYST MADSEN*

*Medical Department B, Frederiksborg County Central Hospital Hillerod, Denmark
{dagger}Statistical Research Unit, University of Copenhagen

Received 18 February 1992; revised 28 September 1992; .

Correspondence Per Fruergaard, Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark.

Abstract

The seven-year prognosis for cardiac events (non-fatal acute myocardial infarction (AMI) or cardiac death) following discharge was related to an electrocardiogram (ECG) at rest and a symptom-limited exercise test in 217 patients admitted with chest pain without confirmed AMI. The follow-up time was 86–98 months, median 88 months. Although the 7-year prognosis was better than in a comparable group of patients with AMI (P<0.0001), the frequency of cardiac events was still very high. Patients with negative T waves, ST depression or elevation, intraventricular block or Q waves at rest, ST abnormalities during exercise or both constituted a high-risk group. In patients without these ECG abnormalities the prognosis was significantly better (P <<0.0001). The percentages without cardiac events after 7 years were 53 and 92 respectively. Patients with a low rise in the rate-pressure product indicative of decreased function of the left ventricle and patients who developed angina pectoris during exercise also had a significantly impaired 7-year prognosis. This non-invasive approach to risk stratification identified a group of non-AMI patients with a high risk for cardiac events, and a group comprising more than 50% of the patients with a very low risk.

Key Words: Electrocardiogram • exercise test • prognosis • acute myocardial infarction • non-acute myocardial infarction


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