Syed Zahed Rasheed, Abdus Samad.
Exercise Stress Test early after acute Myocardial Infarction: predictive value for subsequent development of Congestive Cardiac Failure.
Pak J Cardiol Jan ;10(2-3):41-6.

Congestive cardiac failure (CCF), recurrent myocardial infarction and angina pectoris are the most important complications (luring the years following uncomplicated acute myocardial infarction (AMI). Exercise stress testing (EST) early after AMI is reported to be a safe technique for identifying patients at high risk for developing complications during follow-up. In this study, patients with uncomplicated AMI were subjected to symptom limited EST 3-6 days following AMI. The patients were followed up for atleast one year. The data were analyzed to find out the prognostic value of clinical and exercise test variables for the subsequent development of CCF. A total of 105 patients fulfilling the -inclusion criteria -were included in the final analysis. There were 93 (88.57%) male patients and 12 (11.43%) female patients. These patients were followed up for a mean period 2.57 ± 1.13 years. During this period 31 (29.5%) patients developed CCF (Group-A). Patients without CCF were included in group-B. The mean age of patients in group-A was 50.77 ± 7.53 years and 47.95 ± 8.92 in group-B (p=0.125). The number of patients less than 40 years and 40 years and above were similar in the two groups (p=0.904). There was no significant difference statistically in the two groups with respect to sex (p=0.069); smoking (p=0.182); and type of AMI (p=0.193). The results showed the rate pressure product in group-A was 23400 ± 6341 and in group-B was 27220 ± 5429 (p=0.002). Chest pain during exercise test was observed in 11 (35.5%) patients in group-A and 18 (24.3%) patients in group-B (p=0.354). In group-A, 19 (61.3%%) patients developed ST-segment depression and 2 (6.5%) patients developed ST-segment elevation; while in group-B, 32 (43.2%) patients had ST-segment depression and 3 (4.1%) had ST-segment elevation (p=0.158). There were 21 (67.7%) positive ESTs in group-A as compared to 35 (47.3%) in group-B (p=0.035). The relative risk ratio of developing CCF with regard to type of AMI was 1.92; chest pain during exercise test was 1.71; ST-segment depression was 2.32; and a positive EST was 3.40. It is concluded that chest pain during exercise test, ST-segment depression at peak exercise and a positive stress test are important predictors for subsequent development of CCF after an uncomplicated AMI.

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