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NON-Q-WAVE MI: THE ROLE OF EARLY EXERCISE TESTS.

Patients with non-Q-wave infarctions are at high risk for reinfarction and death and thus frequently undergo pre- discharge exercise testing. This analysis of data from 141 patients who had sustained their first such infarction indicates that early low-level exercise testing may be useful only in certain cases.

The highest cardiac mortality rate occurred among the 30 patients who were unable to exercise (13 percent in the first year). In the remaining 111 patients, exercise testing identified a group at increased risk for cardiac events, but the test was reliable only for patients who had pulmonary congestion. Only one of the 85 patients without congestion died during the next year; six others had nonfatal cardiac events. Given this low adverse-outcome rate, it is not surprising that exercise testing did not enhance risk assessment.

These findings suggest that stable patients who have no evidence of pulmonary congestion and are able to exercise may have a sufficiently good prognosis to allow deferral of testing for a few weeks in favor of a more sensitive, symptom-limited test. However, patients with pulmonary congestion or inability to perform an exercise test are at considerably higher risk that may warrant early coronary angiography.

— THL

Published in Journal Watch General Medicine July 11, 1989

Citation(s):

Krone RJ et al. Risk stratification in patients with first non-Q wave infarction: limited value of the early low level exercise test after uncomplicated infarcts. J Am Coll Cardiol 1989 Jul 14 31-37.

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