[ST segment elevation in the ECG stress test in coronary disease]

The authors investigated in 1986-1991 a group of 122 men after myocardial infarction, their mean age was 56 years, the follow up period 35 and at least 24 months. During the ergometric test "symptom limited" 18 days after the attack it was negative in 55% of the men, in 28% positive (depression of ST and/or coronary pain (and in 17% there were elevations of ST above the pathological Q wave. By the end of the follow up period nobody with a negative baseline test died. 6% with a positive test died, 62% patients with elevation of the ST. All patients with ST had elevations an impaired regional ventricular motility with a low ejection fraction (32%) during radionuclide ventriculography. At the time of examination the availability of coronarography and possible revascularization was minimal. Therefore even a retrospective group is valuable. Patients with elevation of ST after exercise have a generally poorer prognosis and are therefore indicated as a priority group for coronarography or possibly revascularization. ST elevation after a load without a pathological Q wave is less frequent and need not be associated with impaired regional motility and may be the manifestation of a coronary spasm or close proximal coronary stenosis, and is also indicated for angiographic examination, and deepening on the result, for revascularization.