Document Detail

Risk of subsequent cardiac events in stable convalescing patients after first non-Q-wave and Q-wave myocardial infarction: the limited role of non-invasive testing. The Multicenter Myocardial Ischemia Research Group.
MedLine Citation:
PMID:  7728293     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients recovering from myocardial infarction are frequently evaluated by non-invasive tests for evidence of myocardial ischemia before returning to work or full activity. The purpose of this study was to evaluate the prognostic significance of clinical and non-invasive ischemic test variables assessed in 549 stable, convalescing patients (median 2 months) after their first Q-wave (n = 363) and non-Q-wave (n = 186) myocardial infarction. METHODS: The ischemic tests performed were resting ECG, exercise ECG, ambulatory ECG, and stress thallium scintigraphy. RESULTS: Cardiac events (unstable angina requiring hospitalization, non-fatal reinfarction, or death from cardiac causes) were observed during a mean 23-month follow-up in 57 patients (15.7%) with Q-wave and in 31 of patients (16.7%) with non-Q-wave infarction. In a step-wise Cox regression model, the only significant independent predictors of subsequent cardiac events (P < 0.001) were post-infarction angina and insulin-dependent diabetes mellitus. The type of infarction did not make a significant contribution to the risk of cardiac events (P = 0.29). However, an interaction between infarct type and post-infarction angina was of borderline significance (P = 0.065), with angina associated with more cardiac events in patients with non-Q-wave than in those with Q-wave infarction. None of the ischemic tests contributed significantly to the Cox model in predicting cardiac events in either infarct type. CONCLUSION: Stable convalescing patients who have recovered from first Q-wave and non-Q-wave myocardial infarction have similar long-term prognoses. The occurrence of post-infarction angina is associated with increased risk of cardiac events in patients with both infarct types, with more marked effect in non-Q-wave than Q-wave infarctions. Ischemia detected by non-invasive tests performed in the convalescing phase after myocardial infarction was not prognostically useful in either infarct type.
W Zareba; A J Moss; R F Raubertas
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Publication Detail:
Type:  Corrected and Republished Article; Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  5     ISSN:  0954-6928     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  1994 Dec 
Date Detail:
Created Date:  1995-06-01     Completed Date:  1995-06-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1009-18     Citation Subset:  IM    
Department of Medicine, University of Rochester School of Medicine and Dentistry, New York, USA.
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MeSH Terms
Follow-Up Studies
Heart Diseases / diagnosis,  etiology*
Myocardial Infarction / complications*,  physiopathology,  radionuclide imaging
Predictive Value of Tests
Corrected and Republished From:
Coron Artery Dis. 1994 Oct;5(10):857-64   [PMID:  7866606 ]

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