Angiocardiography and Exercise Testing at One Month After a First Myocardial Infarction

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Abstract
The results of exercise testing (77 patients), left ventriculography and coronary arteriography (78 patients) are presented for men under 60 yr old, 1 mo. after a 1st myocardial infarct. Cineangiocardiography revealed that patients with anterior infarction (n = 25) had both poorer left ventricular function and more totally occluded vessels than those with inferior (n = 33) or subendocardial infarction (n = 20). Patients with inferior and subendocardial infarction had a greater proportion of myocardium supplied by subtotal lesions likely to be hemodynamically significant (75-99% cross sectional area loss). Subendocardial infarction was characterized by the best left ventricular function and the lowest number of total coronary occlusions. Stress testing showed that the combination of ischemic ST segment changes and angina during exercise was 91% predictive of severe coronary disease (equivalent to triple vessel disease) while no angina in the presence of a negative test was 81% predictive of mild or moderate disease. Stenoses of 75-99% cross sectional area loss were more common when angina occurred during exercise testing, and both angina and ischemic ST segment changes occurred within 10 min in all 4 patients with hemodynamically significant left main coronary artery lesions. Exercise testing after a 1st myocardial infarct is useful and may provide valuable baseline information in the analysis of long-term prognosis.