Early exercise test vs. clinical parameters in the long-term prognostic management after myocardial infarction

An early exercise test was performed in 317 patients with acute myocardial infarction (AMI). The long-term prognosis was assessed after an average follow-up of 5.7 years. The patients with a small increase in the pressure rate product from rest to maximal exercise and/or wih major ventricular arrhythmias constituted a general prognostic high-risk group. The survival was analyzed further applying the above mentioned exercise parameters in the following clinical subgroups: I) patients with clinical heart failure during hospitalization and/or previous myocardial infarction, II) patients with anterior AMI, III) patients with inferior or indefinite AMI. Within each clinical group there was a highly significant difference in survival between the exercise-determined high-risk and low-risk patients. The exercise parameters were more sensitive and more specific prognostic determinators than the clinical variables. The most striking difference was found in patients with clinical heart failure and/or previous infarction. In this group the exercise-determined high-risk patients had a probability of 5-year survival of 0.238 vs. 0.909 in the corresponding low-risk patients (p less than 0.0005).