Four-year prognostic value of exercise-induced angina and painless ST segment depression early after myocardial infarction.

The aim of this study was to establish if angina pectoris and silent ST segment depression during pre-discharge exercise tests are predictive of 4 years survival after myocardial infarction. Accordingly, 377 consecutive hospital survivors of myocardial infarction underwent symptom-limited bicycle ergometry at hospital discharge. Sixty-eight patients had angina during exercise, 124 patients had silent ST segment depression and 184 had neither angina nor ST depression. The baseline demographic profile, exercise capacity during ergometry and radionuclide left ventricular ejection fraction were comparable in the three groups. The total mortality within 4 years in the three groups was 15%, 21% and 22%, and mortality due to reinfarction or sudden death was 10%, 17% and 14%. When patients on digitalis were excluded, the incidence of mortality due to reinfarction or sudden death in the group with painless ST segment depression was 11%. Coronary artery bypass grafting or percutaneous transluminal coronary angioplasty due to recurrent symptoms was performed in 41%, 20% and 18% respectively of the three groups. It is concluded that conditional upon modern treatment, including secondary prevention with beta-blockers and revascularization procedures in selected patients with symptoms refractory to medical therapy, exercise-induced angina and painless ST segment depression do not identify a group of patients at higher risk of sudden death or fatal reinfarction during the 4 years after myocardial infarction.