对接受溶栓治疗的急性心肌梗死患者进行跑步机压力测试以进行危险分层的重新评估。

Reassessment of treadmill stress testing for risk stratification in patients with acute myocardial infarction treated by thrombolysis.

作者信息

Stevenson R, Umachandran V, Ranjadayalan K, Wilkinson P, Marchant B, Timmis A D

机构信息

Department of Cardiology, London Chest Hospital.

出版信息

Br Heart J. 1993 Nov;70(5):415-20. doi: 10.1136/hrt.70.5.415.

DOI:10.1136/hrt.70.5.415

PMID:8260271

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1025352/

Abstract

OBJECTIVES

To evaluate the role of a treadmill stress test for identifying patients at risk of recurrent ischaemic events after acute myocardial infarction treated by thrombolysis.

BACKGROUND

The natural history of myocardial infarction has changed with the introduction of thrombolytic treatment; there is a lower mortality but a higher incidence of recurrent thrombotic events (reinfarction, unstable angina). The treadmill stress continues to be recommended for risk stratification after acute myocardial infarction even though its value has never been formally reassessed in the thrombolytic era.

METHODS

Prospective observational study in which 256 consecutive patients who presented with acute myocardial infarction treated by thrombolysis underwent an early treadmill stress test and were followed up for 10 (range 6-12) months.

RESULTS

Recurrent ischaemic events occurred in 41 patients (unstable angina 15, reinfarction 21, death five) and a further 21 required revascularisation. Both ST depression at a low workload and low exercise tolerance (< 7 metabolic equivalents of the task (METS) were predictive of recurrent events, with respective hazard ratios of 1.93 (95% confidence interval (95% CI) 1.17-3.20; p < 0.01)) and 1.67 (95% CI 1.0-2.78; p < 0.05). These variables identified 50% and 70% of patients who subsequently sustained a recurrent ischaemic event, but the corresponding values for positive predictive accuracy were only 26% and 21%. Thus they are of limited value as a screening measure for identifying patients likely to benefit from invasive investigation and revascularisation. None of the other variables (ST elevation, haemodynamic responses, ventricular extrasystoles, angina) was significantly associated with recurrent ischaemic events.

CONCLUSIONS

The treadmill stress test is of limited value for identifying patients at risk of recurrent ischaemic events after acute myocardial infarction treated by thrombolysis.

摘要

目的

评估平板运动试验在识别急性心肌梗死溶栓治疗后有复发缺血事件风险患者中的作用。

背景

随着溶栓治疗的引入，心肌梗死的自然病程发生了变化；死亡率降低，但复发血栓事件（再梗死、不稳定型心绞痛）的发生率升高。尽管在溶栓时代平板运动试验的价值从未得到正式重新评估，但它仍被推荐用于急性心肌梗死后的危险分层。

方法

一项前瞻性观察性研究，256例连续的急性心肌梗死溶栓治疗患者接受了早期平板运动试验，并随访10（6 - 12）个月。

结果

41例患者发生复发缺血事件（不稳定型心绞痛15例，再梗死21例，死亡5例），另有21例需要进行血管重建。低负荷时的ST段压低和低运动耐量（<7代谢当量任务（METS））均能预测复发事件，相应的风险比分别为1.93（95%置信区间（95%CI）1.17 - 3.20；p<0.01））和1.67（95%CI 1.0 - 2.78；p<0.05）。这些变量识别出了随后发生复发缺血事件患者的50%和70%，但阳性预测准确性的相应值仅为26%和21%。因此，作为识别可能从有创检查和血管重建中获益患者的筛查措施，它们的价值有限。其他变量（ST段抬高、血流动力学反应、室性期前收缩、心绞痛）均与复发缺血事件无显著相关性。