Uncomplicated first myocardial infarction: Strategy for comprehensive prognostic studies

Abstract

To evaluate the prognostic role of combined cardiac studies (submaximal exercise test, thallium-201 scintigraphy, radionuclide exercise ventriculography, two-dimensional echocardiography, Holter monitoring and cardiac catheterization) in patients with a first acute myocardial infarction without complications during hospital admission, 115 consecutive patients aged less than 65 years were prospectively evaluated. The studies were carried out before hospital discharge and the patients were then clinically followed up for 12 months. During the follow-up period, 69 patients (60%) developed complications, which were severe in 23 (20%). Half of all complications and 70% of severe complications developed during the 1st follow-up month. Logistic regression analysis disclosed that the combination of studies with the highest predictive power for complications (probability of complications 99%) and severe complications (probability of severe complications 95%) was the association of exercise test + thallium-201 + echocardiogram. Four decision models (exercise test + echocardiography, exercise test + radionuclide ventriculography, thallium-201 scintigraphy + echocardiography, thallium-201 scintigraphy + radionuclide ventriculography) allowed the stratification of all patients in a particular risk category (high, intermediate or low). The best decision model was the association of thallium-201 scintigraphy + radionuclide ventriculography (probability of complications if both tests were positive 84%; probability of absence of severe complications if both tests were negative 88%), but there were no significant differences with the other models. Any association of a test detecting residual ischemia or functional capacity, or both (exercise test or thallium-201) and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in significant prognostic information in patients with an uncomplicated first acute myocardial infarction. Additional cardiac catheterization does not improve the predictive power of noninvasive studies, which should ideally be performed before hospital discharge because most complications develop during the 1st follow-up month.

Recomendaciones sobre las indicaciones clínicas de la gated-SPECT de perfusión miocárdica

“…El pronóstico de estos pacientes está en función de la fracción de eyección, el tamaño del infarto y el miocardio en riesgo. Para la estratificación de riesgo es recomendable realizar la gated-SPECT de esfuerzo antes del alta hospitalaria, puesto que la mayor parte de las complicaciones tiene lugar durante el primer mes postinfarto 10,11 .…”

Diagnostic and Prognostic Impact of Nuclear Cardiology in the Management of Acute Coronary Syndromes and Acute Myocardial Infarction

“…Rest LVEF identifies patients at high risk for death (9, 20–22). However, the presence of exercise‐induced ischaemia detected by RNA can further improve risk stratification (26–30) independent of whether the patient has single or multivessel disease (29). This is also true for patients receiving thrombolytic therapy, in whom exercise‐induced ischaemic LV dysfunction is frequently observed.…”