Early Post-myocardial Infarction Treadmill Stress Testing

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Abstract
Limited (heart rate .ltoreq. 120 beats/min) standardized treadmill stress testing was done before hospital discharge in 40 survivors of uncomplicated acute myocardial infarction. Each patient had subsequent coronary arteriography. Twenty-one had inferior, 10 anterior and 9 nontransmural infarctions; in 30 patients this was their 1st infarction. A positive ECG response or angina, or both, occurred in 15 patients and correctly detected most patients with multivessel disease (sensitivity 67%, predictive value 87%) and patients at risk for coronary events; 35% of positive responders admitted for angina in the 1st month after discharge vs. 4% of patients with a negative test (P < 0.05). During a 7 mo. follow-up period, 73% of patients with a positive test result developed angina vs. 16% of those with negative test results (P < 0.001). Predischarge post-myocardial infarction limited stress testing correctly identifies the high-risk subset of patients with multivessel coronary disease and thereby allows intelligent selection of patients for early coronary arteriography.