[Is coronary cineangiography more accurate than early bicycle ergometry test in the identification of high-risk acute myocardial infarction survivors?].

PURPOSE

To determine if attenuated early treadmill stress testing is more or less accurate than cinecoronary arteriography in the identification of high-risk acute myocardial infarction (AMI) survivors.

PATIENTS AND METHODS

In a prospective study 96 non-selected and consecutive AMI survivors underwent cinecoronary arteriography in the 4th week of hospitalization and were followed up for a period of 3 to 39 (21.7 +/- 11.0) months. One-half of the patients were randomly submitted to an attenuated heart rate-limited treadmill stress testing in the 3rd week. Seven patients were lost in the follow-up. Of the remaining 89 patients 5 died of cardiac causes. Cardiac events (death, reinfarction, angina and heart failure) occurred in 26 patients. Multivessel coronary artery disease was found in 67 patients (75%) and mean left ventricular ejection fraction was 49.1 +/- 15.6%. Positive treadmill stress testing for myocardial ischemia occurred in 20 of 43 patients (46%).

RESULTS

All patients who died of cardiac causes or who had a cardiac event had multivessel coronary artery disease, the mean left ventricular ejection fraction was 38.6 +/- 16.6% and 45.2 +/- 16.4%, respectively, and two-thirds of patients had positive stress testing. For cardiac death, multivessel coronary artery disease had better sensitivity than positive stress testing and left ventricular ejection fraction less than 0.3 (100% vs 67% vs 20%, respectively) while ejection fraction had better specificity than stress testing and multivessel coronary artery disease (87% vs 55% vs 21%, respectively). Stress testing had a better positive predictive value than multivessel coronary artery disease and ejection fraction (53% vs 38% vs 36%, respectively while multivessel coronary artery disease had better negative predictive value than stress testing and ejection fraction (100% vs 77% vs and 70%, respectively). The association of data obtained from cinecoronarography study between themselves and with positive treadmill stress testing did not significantly improve the sensitivities, specificities and predictive values in relation to the results obtained by isolated data.

CONCLUSION

In survivors of acute myocardial infarction cinecoronary arteriography is not more accurate than, treadmill stress testing and both have limited value in the identification of patients who are candidates for cardiac death or events in the first few years after AMI. A negative stress testing and coronary arteriography (one-vessel disease) is more informative than a positive one.