Document Detail

Exercise-provoked ST-segment depression and prognosis in patients recovering from acute myocardial infarction. Significance and pitfalls.
MedLine Citation:
PMID:  8429283     Owner:  NLM     Status:  MEDLINE    
The importance of maximal versus submaximal exercise testing and the significance of heart failure on the prognostic value of exercise-provoked ST-segment depression > or = 0.1 mV was studied in 143 patients recovering from acute myocardial infarction. Patients were exercise tested prior to discharge and follow up lasted for up to 18 months (mean 17 months). End-point was first major event (i.e. first non-fatal reinfarction or death). A symptom-limited exercise test was superior to a heart-rate-limited test in detecting ST-segment depressions (27% vs. 20%: P < 0.5), and patients with ST-segment depression at lower heart rates did not have an increased risk of subsequent events compared with patients with ST-segment depression at higher heart rates (14% vs. 27%; NS). Heart failure surpassed ST-segment depression as a risk predictor (34% vs. 18%). Based on a meta-analysis including 13 studies (1987 patients) exercise-provoked ST-segment depression possessed an increased risk of subsequent major events (P < 0.0001; risk ratio = 1.90; 95% confidence limits 1.43,2.51). Thus, ST-segment depression provoked by a symptom-limited test selects patients with an increased risk of subsequent major events. In patients with a history of heart failure exercise-provoked ST-segment depression is of limited value.
C M Jespersen; L Hagerup; N Holländer; J Launbjerg; N C Linde; E Steinmetz
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Journal of internal medicine     Volume:  233     ISSN:  0954-6820     ISO Abbreviation:  J. Intern. Med.     Publication Date:  1993 Jan 
Date Detail:
Created Date:  1993-03-11     Completed Date:  1993-03-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8904841     Medline TA:  J Intern Med     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  27-32     Citation Subset:  IM    
Municipal Hospital, Medical Department 2, Copenhagen, Denmark.
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MeSH Terms
Exercise Test*
Follow-Up Studies
Heart Failure / complications
Myocardial Infarction / complications,  diagnosis,  physiopathology*
Odds Ratio

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