Circulation, Vol 80, 1636-1641, Copyright © 1989 by American Heart Association
L Pilote, J Silberberg, R Lisbona and A Sniderman
The measurement of left ventricular ejection fraction (LVEF) plays a key
role in many strategies for managing patients after acute myocardial
infarction. We tested the hypothesis that exercise capacity 1 month after
myocardial infarction provides additional information in patients with a
low LVEF and therefore assists in risk stratification. One hundred fifteen
patients, with documented myocardial infarction and LVEF less than 35% by
gated radionuclide scan 1 month after acute myocardial infarction, were
followed up for 2 months to 7 years. Exercise capacity was estimated from a
treadmill test 1 month after infarction. Using the Cox proportional hazards
model, exercise capacity was a significant predictor of death or
reinfarction. The relative risk of death, based on a comparison between the
lowermost quintile (less than 4 METS) and uppermost quintile (greater than
7 METS), was 3.5 (95% confidence interval, 1.1-9.7); the relative risk in
the fourth, third, and second quintile was 2.7, 2.1, and 1.6, respectively.
In a multivariate analysis, the observed effect of a good exercise capacity
was independent of LVEF. These data indicate that in patients with a low
LVEF after myocardial infarction, useful prognostic information can be
obtained from exercise testing.
ARTICLES
Prognosis in patients with low left ventricular ejection fraction after myocardial infarction. Importance of exercise capacity
Division of Cardiology, Royal Victoria Hospital, Montreal, Quebec, Canada.
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