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(Circulation. 1999;100:2040-2042.)
© 1999 American Heart Association, Inc.

Editorials

Risk Stratification Soon After Acute Infarction

Frans J. Th. Wackers, MD; Barry L. Zaret, MD

From the Cardiovascular Nuclear Imaging Laboratory, Department of Diagnostic Radiology, and the Cardiovascular Medicine Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.

Correspondence to Frans J.Th. Wackers, MD, Cardiovascular Nuclear Imaging and Exercise Laboratories, Yale University School of Medicine, 333 Cedar St TE-2, PO Box 208042, New Haven, CT 06520-8042. E-mail frans.wackers@diagrad.med.yale.edu

Key Words: Editorials • myocardial infarction • ischemia • stress • scintigraphy • prognosis

Two decades ago, exercise testing "soon after acute myocardial infarction" meant that stress testing was performed 3 weeks after the acute event.¹ It was conventional wisdom that patients recovering from acute myocardial infarction should avoid physical activities exceeding a workload of 3 METs for some time.² Formal physical rehabilitation was not commenced before 10 weeks after infarction. In 1979, Theroux et al³ challenged this concept by submitting patients with recent and uncomplicated acute infarction to submaximal exercise electrocardiography at the time of hospital discharge, which at that time was 11 days after infarction. Not only was submaximal exercise testing shown to be safe in such patients, it also provided important prognostic information concerning the occurrence of future cardiac events. Although this landmark study set the stage for the use of exercise testing to evaluate patients with recent myocardial infarction, the prognostic power of exercise electrocardiography in later studies was found to be limited.⁴ This was probably due to difficulties in interpreting exercise ECGs in patients with abnormal resting ST-T segments. A few years later, Gibson et al⁵ showed that the addition of ²⁰¹Tl myocardial perfusion imaging to submaximal predischarge exercise electrocardiography significantly enhanced the power of the test for predicting future cardiac events compared with that of exercise electrocardiography alone. More recently, Mahmarian et al^{6 7} demonstrated that quantitative single photon emission computed tomography (SPECT) myocardial perfusion imaging with either exercise or pharmacological vasodilation in patients with recent myocardial infarction allowed patients to be stratified into low-, intermediate-, or high-risk groups. . . . [Full Text of this Article]

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