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Influence of coronary lesions morphology on treadmill exercise stress testing after acute myocardial infarction
A Galrinho1, R Ferreira, J Serra
1Department of Cardiology, Santa Marta Hospital, Lisbon.
Insights
Complex coronary lesions in the infarct-related artery are associated with a higher incidence of ischemic responses during exercise stress tests after myocardial infarction. This finding highlights the importance of lesion morphology in assessing post-MI patient risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Assessing exercise stress test (EST) performance after myocardial infarction (MI) is crucial for risk stratification.
- Infarct-related artery (IRA) lesion morphology may influence post-MI cardiac function and exercise capacity.
Purpose of the Study:
- To investigate the impact of IRA lesion morphology on exercise stress test results following a first myocardial infarction.
Main Methods:
- Coronary angiography and pre-discharge EST (Bruce protocol) were analyzed in 105 first MI patients.
- Patients were grouped based on the presence (Group I) or absence (Group II) of complex IRA lesions (ulcers, thrombus, etc.).
- Ergometric parameters and ischemic responses (ST depression, angina) were compared between groups.
Main Results:
- No significant differences in age, sex, left ventricular function, or vessel disease severity were found between groups.
- Ergometric parameters like exercise time, METS, and maximal heart rate did not differ significantly.
- Patients with complex IRA lesions showed a significantly higher incidence of ischemic responses (ST depression, angina) on EST.
Conclusions:
- Complex coronary lesions in the IRA are linked to a higher likelihood of residual ischemic phenomena detected by EST.
- These findings suggest that IRA lesion morphology may be an important factor in evaluating patients post-MI.
- Further research is needed to determine the prognostic value of specific coronary plaque characteristics.
Objectives:
To evaluate the influence of infarct related artery lesion morphology on the exercise stress test performed after a first myocardial infarction.
Methods:
We reviewed coronary angiography and the exercise stress test performed before discharge from hospital in 105 consecutive patients (91.4% male, mean age 49.6 +/- 9.2 years) with first acute myocardial infarction. Complex coronary lesions were defined by the presence of one of the following characteristics: ulcers, thrombus, shoulders, irregularities and eccentricity. According to either the existence or absence of complex coronary lesions, two groups were considered: Group I--42 patients with complex coronary lesions, and Group II--47 patients without these characteristics in coronary angiogram. Sixteen pts (14%) were excluded because the infarct related artery was occluded or existence of complex lesions in other coronary artery not related to the infarct. Left ventricular systolic function was analyzed using the "CASS score". Exercise stress test performed between the 10th and the 15th day after myocardial infarction, using Bruce protocol, were reviewed. The following parameters were analyzed: exercise time, number of metabolic equivalent units (METS), maximal heart rate attained, double product variation and number of patients with significant ST segment depression and/or angina.
Results:
No statistically significant differences between the two groups were obtained as far as age, sex, left ventricular function, number of diseased vessels and lesions severity. From the analysis of ergometric parameters we did not find any difference between the two groups of patients about exercise time (Group A--8.37 +/- 2.6 versus (vs) Group B 8.38 +/- 3.18), METS (Group A--8.22 +/- 2.87 vs Group B--8.13 +/- 2.97), maximal heart rate (Group A--88.2% vs Group B--87.5%) and double product variation (Group A--14547 +/- 5492 vs Group B--14553 +/- 5387). However, the number of ischemic response (defined by usual criteria of St-segment depression and/or angina) was significantly greater in patients with complex coronary lesions (ST--segment depression: Group A--26 pts vs Group B--19 pts, p < 0.05/Angina: Group A--16 pts vs Group B--4 pts, p < 0.001). Thus, complex coronary lesions are related to a high incidence of residual ischemic phenomena detected by electrocardiographic exercise stress test performed on predischarge period of acute myocardial infarction. Further studies will be necessary to show the prognostic value of particular angiographic characteristics found in coronary plaques.