Objective. Several noninvasive methods have prognostic information regardin
g mortality and new coronary events after an acute myocardial infarction (A
MI). The practical for clinical decision-malting in the immediate postmyoca
rdial infarction (MI) period is, however, less evident. We investigated con
secutive patients with AMI treated with thrombolysis to further clarify thi
Design. A total of 100 patients (27% women) aged 64 +/- 9 years (mean +/- S
D) were studied. Risk assessment based on a clinical score system, myocardi
al perfusion scintigraphy single photon emission computed tomography (SPECT
) at rest and during adenosine stress, echocardiography, radionuclide angio
graphy, symptom-limited exercise stress test, and 24-h Holter ECG recording
with ST-analysis and analysis of heart rate variability (HRV) were perform
ed 5-8 days after hospital admission. Mortality, nonfatal reinfarction, and
the need for revascularization were followed during 12 months.
Setting. A university hospital.
Results, A total of 6 patients died, seven had a nonfatal reinfarction, and
23 were revascularized. inability to perform an exercise lest (P = 0.004)
and an ejection fraction (EF) <40% (P = 0.002) were the only parameters sep
arating those who died from the survivors. No method could predict a nonfat
al reinfarction. Patients suffering either death or nonfatal reinfarction h
ad a clinical risk assessment score 2 points higher (8.8 vs. 6.7, P = 0.05)
than the group without such events. A positive symptom-limited exercise st
ress test (P = 0.027), ST-depressions on Holter ECG (P = 0.04), and reversi
bility on myocardial perfusion scintigraphy (P = 0.029) predicted the need
Conclusion. Risk assessment based on clinical information, exercise stress
testing, and an estimate of left ventricular function (e.g. via echocardiog
raphy) contribute with prognostic information in thrombolysed MI-patients.
Additional noninvasive investigations such as adenosine-SPECT, analysis of
HRV, and Holter-monitoring do not add to these commonly available tools in
risk stratification of subjects at low to medium risk.