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European Heart Journal 1988 9(9):938-947;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Identification of patients at low risk of dying after acute myocardial infarction, by simple clinical and submaximal exercise test criteria

S. CAMPBELL*, R. A'HERN, P. QUIGLEY*, R. VINCENT, D. JEWITT* and D. CHAMBERLAIN

*The Cardiac Department of King's College Hospital London and The Royal Sussex County Hospital Brighton and The Cancer Research Campaign Clinical Trials Centre, King's College Hospital Medical School London, U.K.

Received 29 September 1987; revised 17 February 1988; .

Address for reprints. Dr D. A. Chamberlain, Cardiac Department. Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, U.K.

Abstract

A consecutive series of 559 hospital survivors of acute myocardial infarction aged less than 66 years were studied; 93 were designated prospectively as low-risk because they were suitable for early submaximal exercise testing and had none of the following clinical or exercise test ‘risk’: (1) angina for at least one month prior to infarction; (2) symptomatic ventricular arrhythmias, or (3) recurrent ischaemic pain, both after the first 24 h of infarction; (4) cardiac failure; (5) cardiomegaly; and (6) an abnormal exercise test (angina, ST-depression or poor blood pressure response). Altogether 301 patients were exercised; their mortality over a median follow-up of 2.4 years was 10.2%, versus 24.6% in the 258 patients not exercised (P=0.0005). Absence of clinical ‘risk factors’ alone, in the exercised patients, identified 156 with a mortality of 5.4% versus 15.6% in the 145 with at least one clinical ‘risk factor’ (P=0.004). The fully defined low-risk group comprised 93 of the former patients who had neither clinical nor exercise test ‘risk factors’. None of these patients died compared with 19 of those with at least one ‘risk factor’ (mortality=14.7% P=0.002). Their respective rates of non-fatal reinfarction were similar and never exceeded 5% per annum. Therefore, simple clinical and exercise test criteria can positively identify low-risk patients after infarction in whom secondary prevention may be inappropriate.

Key Words: Acute myocardial infarction • low-risk survivors


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