Prognostic value of predischarge radionuclide ventriculography at rest and exercise after acute myocardial infarction treated with thrombolytic therapy or primary coronary angioplasty

Abstract

SummaryBuckground: Previous studies have demonstrated the prognostic value of radionuclide ventriculography at rest and exercise in patients post myocardial infarction (MI). The number of studies in patients treated with modem reperfusion techniques, including thrombolysis or primary angioplasty, however, is limited.H.yporhesis: The aim of this study was to evaluate the prognostic significance of predischarge radionuclide ventriculography at rest and exercise in patients with acute MI treated with thrombolysis or primary angioplasty.Methods: A total of272 consecutive patients with acute MI who were randomized to thrombolysis or primary coronary angioplasty underwent predischarge resting and exercise radionuclide ventriculography. Left ventricular ejection fraction at rest, decrease in ejection fraction during exercise >5 units below the resting value, angina pectoris, ST-segment depression, and exercise test ineligibility were related to subsequent cardiac events (cardiac death, nonfatal reinfarction) during Results: During a mean follow-up of 30 f I0 months, cardiac death occurred in 11 (4%) patients and nonfatal reinfarction in 14 (5%) patients. Resting left ventricular ejection fraction was the major risk factor for cardiac death. In patients follow-up. with an ejection fraction < 40% cardiac death occurred in 16% compared with 2% in those with an ejection fraction 2 40% (p = 0.0004). In addition, cardiac death tended to be higher in patients ineligible than in those eligible for exercise testing (1 1 vs. 3%, p = 0.08). None of the other exercise variables (decrease in ejection fraction during exercise >S units below the resting value, angina pectoris or ST-segment dcpression) were predictive for cardiac death. When all exercise test variables in each patient were combined and expressed as a risk score, a low risk (n = 185) and a higher risk (n = 87) group of patients could be identified, with cardiac death occurring in 1 and lo%, respectively. As the predictive accuracy of a negative test was high, radionuclide ventriculography was of particular value in identifying patients at low risk for cardiac death. Radionuclide ventriculography was not able to predict recurrent nonfatal MI.Conclusion: In patients with MI treated with thrombolysis or primary angioplasty, radionuclide ventriculography may be helpful in identifying patients at low risk for subsequent cardiac death. In this respect, left ventricular ejection fraction at rest was the major determinant. Variables retlecting residual myocardial ischemia were of limited prognostic value. Identification of a large number of patients at low risk allows selective use of medical resources during follow-up in this subgroup and has significant implications for the cost e f t ctiveness of reperfusion therapies.

The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction

“…This is because a stress response is accompanied by high levels of catecholamines and cortisol, and these hormones increase glycogenolysis and lipolysis and reduce insulin sensitivity, resulting in elevated glucose levels (14). Therefore, patients with elevated glucose levels may represent patients with an increased stress response, for example, due to more severe hemodynamic compromise or more extensive myocardial damage (15,16). Stress hyperglycemia increases mortality, congestive heart failure and cardiogenic shock after AMI (17).…”

Scintigraphic Techniques for Early Detection of Cancer Treatment–Induced Cardiotoxicity

“…If this compensatory mechanism fails, left ventricular dysfunction first manifests during exercise. However, conflicting results exist on the superior prognostic value of exercise MUGA, compared with MUGA at rest (51,52). Furthermore, because certain cancers and coronary heart disease have age and smoking as 2 common major risk factors, many of these patients undergo gated myocardial perfusion SPECT to rule out ischemic heart disease.…”

Electrocardiographic exercise stress testing: An update beyond the ST segment

“…A meta-analysis showed that if the predischarge TET is normal following an acute MI, there is a < 10% event rate at 1 year; if abnormal, the event rate increased to 10-20% [38]. However, another study using TET in conjunction with nuclear imaging showed that neither angina pectoris nor ST-segment depression during the stress test was independently predictive for cardiac death [39]. In fact, the most powerful predictor of subsequent cardiac mortality was a lower ejection fraction at rest.…”