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(Circulation. 1995;91:1855-1860.)
© 1995 American Heart Association, Inc.

Articles

Evaluation of the Postinfarct Patient

Bertram Pitt, MD

From the Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center (Ann Arbor).

Correspondence to Dr Bertram Pitt, Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0366.

Key Words: testing • stress • exercise • infarcts • mortality

	Introduction

 
A recent study by Moss et al¹ in which the authors evaluated in 966 patients discharged from the coronary care unit, the role of exercise ECG, exercise ²⁰¹Tl myocardial perfusion imaging, and ambulatory (Holter) ECG recording in detecting silent myocardial ischemia 1 to 6 months after discharge has called into question the prognostic usefulness of stress testing and detection of myocardial ischemia after infarction. The authors noted that the presence of ST-segment depression on the exercise ECG failed to predict recurrent ischemic events. A positive exercise ²⁰¹Tl myocardial stress test had only a borderline significant effect in predicting ischemic events. The difference between patients with and those without a positive exercise ²⁰¹Tl stress test was not, however, evident for several years. Similarly, the ambulatory (Holter) ECG used to detect silent myocardial ischemia failed to predict recurrent myocardial infarction. The investigators, however, did note that patients with an exercise duration of <6 minutes and ST-segment depression had a relatively high, threefold to fourfold, incidence of recurrent ischemic events and that those with redistribution of myocardial ²⁰¹Tl on exercise testing who also had increased lung uptake of ²⁰¹Tl—suggesting multivessel coronary artery disease, compromised left ventricular function, or both—were at increased risk for recurrent ischemic events. However, these high-risk subsets comprised <3% of the patients studied and accounted for <6% of the recurrent ischemic events. The authors concluded that detection of silent or symptomatic myocardial ischemia by noninvasive testing in stable patients 1 to 6 months after an acute coronary event is not . . . [Full Text of this Article]

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