RESUMO
Acute myocardial infarction [AMI] carries high mortality during the years to follow. Patients who are at increased risk of dying during follow-up can be identified early after AMI. Exercise stress test [EST] is one of the most useful technique for this purpose. In this study patients were subjected to EST 3 to 6 days after uncomplicated AMI. The data were analyzed to see the predictive value of various clinical and exercise test variables for mortality during follow-up. A total of 105 patients who completed at least one year of follow-up were included in the final analysis. 93 [88.57%] were male and 12 [11.43%] were female patients. These patients were followed up for a mean period of 2.57 t 1.12 years. 21 [20.0%] patients died during this period [Group-A]. 84 [80.0%] patients remain alive at the end of the study [Group-B]. The mean age of patients in group-A was 53.86 f 7.59 years as compared to 47.51 t 8.40 years in group-B [p=0.002]. In group-A 14 [66.66%] patients had anterior wall myocardial infarction and 7 [33.33%] had inferior wall myocardial infarction. While in group-B 35 [41.67%] patients had anterior wall infarction and 49 [58.33%] patients had inferior wall myocardial infarction [p=0.040]. The other clinical variables i.e. distribution of patients in the two age groups [p=0.257]; sex [p=0.490]; smoking [p=0.512]; and rate pressure product [p=0.132] did not show any significant difference between the two groups. The results showed response to exercise was significantly different in the two groups with respect to chest pain during exercise [p=0.010]; ST-segment shift [p=0.05] and results of exercise test [p=0.027]. The first year mortality was 5.7% with 83.33% patients having positive EST, and the second year mortality, was 7.07% with 85.71% patients having positive EST. The overall mortality was 20% during this period with 76.19% patients having positive EST. The relative risk of dying during follow-up was 2.80 times more with anterior wall myocardial infarction; 4.03 times more with chest pain during exercise; 3.33 times more with ST segment depression; 5.87 times more with ST segment elevation and 3.6 times more with positive EST. It is concluded age, anterior wall myocardial infarction, chest pain during exercise, ST-segment depression or elevation at peak exercise and a positive EST are important predictors of mortality after AMI