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Uncomplicated non-Q wave myocardial infarction: long-term prognosis with a conservative echo-stress guided management
Enrico Cecchi1, Giovanni Brusasco, Massimo Tidu
1Cardiology Department, Maria Vittoria Hospital, ASL 3, Turin, Italy. cecchi2@libero.it
Insights
Conservative management for non-Q wave myocardial infarction is effective. Dipyridamole echocardiography testing (DET) helps identify low-risk patients, guiding treatment decisions for better outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Imaging
Background:
- Debate exists regarding optimal management strategies for non-Q wave myocardial infarction (NQMI).
- Conservative treatment approaches are being evaluated for long-term patient outcomes.
- In-hospital stress testing plays a role in risk stratification for NQMI patients.
Purpose of the Study:
- To evaluate the long-term outcomes of a conservative management strategy for first uncomplicated non-Q wave myocardial infarction.
- To assess the utility of in-hospital stress echocardiography and treadmill exercise in guiding treatment decisions.
- To determine the predictive value of dipyridamole echocardiography test (DET) in risk stratification.
Main Methods:
- 134 consecutive patients with first uncomplicated NQMI were studied.
- Patients underwent dipyridamole echocardiography test (DET) 5-7 days post-admission and treadmill testing before discharge.
- Coronary angiography and revascularization were performed based on stress test results.
Main Results:
- Low rates of early (2.9%) and delayed (15%) hard events were observed.
- Negative DET results correlated with a lower risk of spontaneous and hard events.
- Multivariate analysis identified DET as the sole predictor of spontaneous events within 1 year and delayed events (p=0.0001).
Conclusions:
- Revascularization guided by stress echocardiography yields good short- and long-term outcomes in stabilized NQMI.
- Patients with negative DET exhibit a very low event rate.
- Positive DET identifies a high-risk patient group, irrespective of subsequent treatment.
Background:
Whether an invasive or a conservative strategy should form the basis of an optimal management strategy for non-Q wave myocardial infarction is at present still subject of debate. We reported our observational experience with the long-term follow-up of patients with a first uncomplicated non-Q wave myocardial infarction and submitted to a conservative treatment strategy based on the in-hospital stress echocardiography and treadmill exercise.
Methods:
We studied 134 consecutive patients admitted for a first uncomplicated non-Q wave myocardial infarction between 1991 and 1994. All patients were submitted to a dipyridamole echocardiography test (DET) between 5-7 days after admission and to a treadmill test before discharge. Coronary angiography and myocardial revascularization (coronary angioplasty or coronary artery bypass grafting) were performed according to the outcomes of the stress echo and treadmill test.
Results:
The early and delayed follow-up results were quite good: 2.9% early hard events, 15% delayed hard events. DET negativity identified patients with a lower risk of both spontaneous and hard events. Multivariate analysis indicated the DET as the only predictive variable of spontaneous events within 1 year (p = 0.0001), of delayed spontaneous events (p = 0.0001) and of delayed hard events (p = 0.05).
Conclusions:
In this study, revascularization procedures performed on the basis of stress echo result in good short- and long-term outcomes in stabilized uncomplicated non-Q wave myocardial infarction. The patients with a negative DET had a very low rate of events. DET positivity identifies a higher risk group of patients, whatever treatment they subsequently undergo.