Early Exercise Test vs. Clinical Parameters in the Long‐Term Prognostic Management after Myocardial Infarction

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Abstract
An early exercise test was performed in 317 patients with acute myocardial infarction (AMI). The long‐term prognosis was assessed after an average follow‐up of 5.7 years. The patients with a small increase in the pressure rate product from rest to maximal exercise and/or with major ventricular arrhythmias constituted a general prognostic high‐risk group. The survival was analyzed further applying the above mentioned exercise parameters in the following clinical subgroups: I) patients with clinical heart failure during hospitalization and/or previous myocardial infarction, II) patients with anterior AMI, III) patients with inferior or indefinite AMI. Within each clinical group there was a highly significant difference in survival between the exercise‐determined high‐risk and low‐risk patients. The exercise parameters were more sensitive and more specific prognostic determinators than the clinical variables. The most striking difference was found in patients with clinical heart failure and/or previous infarction. In this group the exercise‐determined high‐risk patients had a probability of S‐year survival of 0.238 vs. 0.909 in the corresponding low‐risk patients (p < 0.0005).