[ST segment elevation in the ECG stress test in coronary disease]
1Ustav fyziologie a patofyziologie Zdravotnĕ sociální fakulty Ostravské univerzity, Ostrava.
Insights
A negative exercise stress test after myocardial infarction predicts survival. ST-segment elevation during exercise testing in patients post-myocardial infarction indicates a poor prognosis and need for further cardiac evaluation.
Area of Science:
- Cardiology
- Exercise Physiology
Context:
- Investigated 122 men post-myocardial infarction (MI) between 1986-1991.
- Mean age 56 years, with follow-up of at least 24-35 months.
Purpose:
- To evaluate the prognostic value of exercise stress testing in men after myocardial infarction.
- To identify patient subgroups requiring priority for further cardiac investigation and intervention.
Summary:
- Symptom-limited ergometric tests were performed 18 days post-MI.
- Negative tests (55%) had no mortality. Positive tests (28%) had 6% mortality.
- ST-segment elevation (17%) correlated with impaired ventricular motility, low ejection fraction (32%), and 62% mortality.
Impact:
- Exercise stress test results, particularly ST-segment elevation, are critical indicators of prognosis post-MI.
- Patients with ST-segment elevation require priority for coronary angiography and potential revascularization.
- ST elevation without pathological Q waves may indicate coronary spasm or stenosis, also warranting angiographic evaluation.
Abstract:
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.
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