Caires G, Mendes M, Mesquita A, Brízida L, Seabra-Gomes R
Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide.
Acta Med Port. 1998 Oct;11(10):831-8.
To assess the prognostic value of predischarge exercise testing (ET) in patients hospitalized for acute myocardial infarction (AMI).
Department of Cardiology in a reference hospital for Interventional Cardiology
Between January 1990 and December 1994, 178 patients hospitalized for AMI were discharged and referred to the outpatient clinic (mean follow up, 1049 +/- 612 days). Eighty-two percent of these patients were men, mean age--56 +/- 12 years. Patients that did not perform predischarge ET (Group A, n 77) were retrospectively compared with those who did (Group B, n = 101). In relation to demographic and clinical characteristics; we analysed cardiac events (CE) and death during the first 18 months after discharge in both groups. In group B patients, we studied the relation of ET parameters (duration of exercise, occurrence of exercise-induced ischaemia and arrhythmias, maximum heart rate, blood pressure response, rate pressure product and severity score) to CE and death during the first 18 months after AMI.
The proportion of patients aged 70 years or older was greater in group A (23% vs 3%, P < 0.001). In this group, there was a greater prevalence of recurrent ischaemia (51% vs 29%, P < 0.001) and left ventricular dysfunction (42% vs 25%, P < 0.05). Group A patients were also submitted to less thrombolysis (45% vs 62%, P < 0.05) and to revascularization procedures (25% vs 41%, P < 0.05). In group B patients, the incidence of CE did not differ with respect to duration of ET, rate pressure product or maximum heart rate. Incidence of CE was greater in patients with exercise-induced ischaemia (38% vs 15%, P < 0.05), severity score > 2 (45% vs 18%, P < 0.02) and inadequate rise (< 30 mmHg) in systolic blood pressure (39% vs 13%, P < 0.02). The total incidence of CE and revascularization was also greater in patients with exercise-induced ischaemia (88% vs 49%, P < 0.001), severity score > 2 (95% vs 56%, P < 0.02) and inadequate rise in systolic blood pressure (93% vs 45%, P < 0.001).
In patients without indication for ET as part of risk stratification after AMI, clinical characteristics were more severe as defined by age greater than 70 years, residual ischaemia and left ventricular dysfunction. Patients that performed ET had smaller risk, except when presenting exercise-induced ischaemia, severity score > 2 and inadequate rise in systolic blood pressure.
评估急性心肌梗死（AMI）住院患者出院前运动试验（ET）的预后价值。
一家介入心脏病学参考医院的心脏病科
1990年1月至1994年12月期间，178例因AMI住院的患者出院后被转诊至门诊（平均随访时间为1049±612天）。这些患者中82%为男性，平均年龄为56±12岁。将未进行出院前ET的患者（A组，n = 77）与进行了ET的患者（B组，n = 101）进行回顾性比较。就人口统计学和临床特征而言，我们分析了两组患者出院后头18个月内的心脏事件（CE）和死亡情况。在B组患者中，我们研究了ET参数（运动持续时间、运动诱发缺血和心律失常的发生情况、最大心率、血压反应、心率血压乘积和严重程度评分）与AMI后头18个月内CE和死亡的关系。
A组中70岁及以上患者的比例更高（23%对3%，P<0.001）。在该组中，复发性缺血（51%对29%，P<0.001）和左心室功能障碍（42%对25%，P<0.05）的患病率更高。A组患者接受溶栓治疗（45%对62%，P<0.05）和血运重建术（25%对41%，P<0.05）的比例也更低。在B组患者中，CE的发生率在ET持续时间、心率血压乘积或最大心率方面没有差异。运动诱发缺血的患者CE发生率更高（38%对15%，P<0.05），严重程度评分>2的患者（45%对18%，P<0.02）以及收缩压升高不足（<30 mmHg）的患者（39%对13%，P<0.02）也是如此。运动诱发缺血的患者（88%对49%，P<0.001）、严重程度评分>2的患者（95%对56%，P<0.02）以及收缩压升高不足的患者（93%对45%，P<0.001）的CE和血运重建总发生率也更高。
在AMI后作为风险分层一部分无ET指征的患者中，按照年龄大于70岁、残余缺血和左心室功能障碍定义，临床特征更为严重。进行ET的患者风险较小，但存在运动诱发缺血、严重程度评分>2和收缩压升高不足的情况除外。
