Uncomplicated non-Q wave myocardial infarction: long-term prognosis with a conservative echo-stress guided management strategy.

BACKGROUND

Whether an invasive or a conservative strategy should form the basis of an optimal management strategy for non-Q wave myocardial infarction is at present still subject of debate. We reported our observational experience with the long-term follow-up of patients with a first uncomplicated non-Q wave myocardial infarction and submitted to a conservative treatment strategy based on the in-hospital stress echocardiography and treadmill exercise.

METHODS

We studied 134 consecutive patients admitted for a first uncomplicated non-Q wave myocardial infarction between 1991 and 1994. All patients were submitted to a dipyridamole echocardiography test (DET) between 5-7 days after admission and to a treadmill test before discharge. Coronary angiography and myocardial revascularization (coronary angioplasty or coronary artery bypass grafting) were performed according to the outcomes of the stress echo and treadmill test.

RESULTS

The early and delayed follow-up results were quite good: 2.9% early hard events, 15% delayed hard events. DET negativity identified patients with a lower risk of both spontaneous and hard events. Multivariate analysis indicated the DET as the only predictive variable of spontaneous events within 1 year (p = 0.0001), of delayed spontaneous events (p = 0.0001) and of delayed hard events (p = 0.05).

CONCLUSIONS

In this study, revascularization procedures performed on the basis of stress echo result in good short- and long-term outcomes in stabilized uncomplicated non-Q wave myocardial infarction. The patients with a negative DET had a very low rate of events. DET positivity identifies a higher risk group of patients, whatever treatment they subsequently undergo.