Exercise versus recovery electrocardiography in predicting mortality in patients with uncomplicated myocardial infarction

被引:11
作者
Bigi, R
Cortigiani, L
Gregori, D
De Chiara, B
Fiorentini, C
机构
[1] Niguarda Hosp, CNR, Inst Clin Physiol, I-20162 Milan, Italy
[2] Campo Marte Hosp, Cardiovasc Unit, Lucca, Italy
[3] Univ Turin, Dept Publ Hlth & Microbiol, Turin, Italy
[4] Univ Milan, S Paolo Acad Hosp, Dept Cardiol, Milan, Italy
关键词
exercise; electrocardiography; coronary artery disease; stress testing; prognosis; myocardial infarction;
D O I
10.1016/j.ehj.2004.02.007
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Exercise testing after acute myocardial infarction has limited prognostic accuracy. We prospectively used stress-recovery, heart rate-adjusted, ST-segment analysis to predict cardiac death in this clinical setting. Methods The stress-recovery index, defined as the difference in absolute values of the areas designated by ST depression in the heart-rate domain during exercise and recovery, was derived in 708 survivors of a first myocardial infarction. To assess whether it contributed additional prognostic information to routinely obtained information, clinical data, resting ejection fraction, and exercise testing data were entered into a sequential Cox model; the stress-recovery index was entered last. Model validation was performed by bootstrapping adjusted for the degree of optimism in estimates. Survival curves were set up using Kaplan-Meier analysis and compared by the log-rank test. Results Hypertension (OR 1.3, 95%CI 0.9-4.6), exercise capacity (OR 0.6, 95%CI 0.3-1.1 for the interquartile difference in kilopounds per minute), and the stress-recovery index (OR 0.7, 95%CI 0.5-0.9 for the interquartile difference) were independent predictors of cardiac death at a median follow-up of 32 months. However, the stress-recovery index enhanced the prognostic power of the model on top of clinical and exercise testing variables in all diagnostic subgroups according to ST-segment analysis and significantly discriminated survival. A simple nomogram was generated from the fitted Cox model to estimate risk in individual patients. Conclusions Stress-recovery, heart rate-adjusted, ST-segment analysis predicts cardiac death after acute myocardial infarction and provides additional prognostic information over clinical and exercise testing data. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:558 / 564
页数:7
相关论文
共 37 条
[1]  
Akaike H., 1973, 2 INT S INFORM THEOR, P267, DOI [DOI 10.1007/978-1-4612-1694-0_15, 10.1007/978-1-4612-1694-0_15]
[2]  
AMEISEN O, 1985, BRIT HEART J, V53, P547
[3]  
AMICO A, 1987, European Heart Journal, V8, P190
[4]   PREDICTION OF MORTALITY FOLLOWING HOSPITAL DISCHARGE AFTER THROMBOLYSIS FOR ACUTE MYOCARDIAL-INFARCTION - IS THERE A NEED FOR CORONARY ANGIOGRAPHY [J].
ARNOLD, AER ;
SIMOONS, ML ;
DETRY, JMR ;
VONESSEN, R ;
VANDEWERE, F ;
DECKERS, JW ;
LUBSEN, J ;
VERSTRAETE, M .
EUROPEAN HEART JOURNAL, 1993, 14 (03) :306-315
[5]  
BIGI R, 1994, EUR HEART J, V15, P1240
[6]   Incremental prognostic value of stress echocardiography as an adjunct to exercise electrocardiography after uncomplicated myocardial infarction [J].
Bigi, R ;
Desideri, A ;
Galati, A ;
Bax, JJ ;
Coletta, C ;
Fiorentini, C ;
Fioretti, PM .
HEART, 2001, 85 (04) :417-423
[7]  
BIGI R, 1999, ANN NONINVAS ELECTRO, V4, P60
[8]   HEMODYNAMIC DETERMINANTS OF EXERCISE ST-SEGMENT DEPRESSION IN CORONARY PATIENTS [J].
DETRY, JMR ;
PIETTE, F ;
BRASSEUR, LA .
CIRCULATION, 1970, 42 (04) :593-&
[9]   Prognostic value of exercise testing in a cohort of patients followed for 15 years after acute myocardial infarction [J].
Domínguez, H ;
Torp-Pedersen, C ;
Koeber, L ;
Rask-Madsen, C .
EUROPEAN HEART JOURNAL, 2001, 22 (04) :300-306
[10]  
Efron B., 1994, INTRO BOOTSTRAP, DOI DOI 10.1201/9780429246593