[Long-term (10 years) predictive value of the exercise test after myocardial infarct and significance of the longitudinal repetition of the test during follow-up]. / Valore predittivo a lungo termine (10 anni) della prova da sforzo nel post-infarto e significato della ripetizione del test longitudinalmente nel corso del follow-up.

Our follow-up after myocardial infarction consists of 321 patients followed for 10 years or until death. 147 patients, free of clinical features associated with high risk of subsequent events, underwent a late exercise test at cycloergometer 6 to 17 months after infarction. Ten year mortality was 48.3% and 10.3% in patients with a positive or a negative test respectively (p less than 0.0001). Incidence of nonfatal reinfarction was 4.6% and 33.3% respectively (p less than 0.001). 108 patients underwent a second test later in the follow-up (2.8 +/- .9 years): in 27 patients who were positive at first test the second test was also positive and mortality was 33.3%. Sixteen out of 81 patients with a former negative test resulted positive at a repeat test and mortality was 37.5% vs a 3% mortality rate among 65 patients who were negative at both tests. Thus long-term prognostic significance of exercise stress testing after acute myocardial infarction is confirmed and extended, despite limitation of a late test. Moreover, the second test along the follow-up allows further stratification. In conclusion, patients with a negative test and without clinical features predictive of poor prognosis constitute a very low risk group who need not undergo invasive testing, whereas patients with a positive result or who become positive at following test deserve further evaluation and may become bypass candidates in the ensuing years.

[10-year survival after myocardial infarction. Longitudinal study of a hospital population]. / Sopravvivenza a 10 anni dopo l'infarto del miocardio. Studio longitudinale su una popolazione ospedaliera.

In this study, 321 patients discharged from hospital after an acute myocardial infarction were followed for 10 years or until death. Death rate was 46.4% and 30.8% of all fatalities was sudden. In over 80% of the cases death was from cardiac causes and frequently occurred out of hospital. Univariate analysis showed that age, female sex, previous infarction, diabetes, heart failure during hospitalization, heart murmur, NYHA class III or IV, post-infarction angina, intraventricular conduction defects, cardiomegaly, ST displacement, were all associated with an increased death rate. A positive exercise test 6-17 months after infarction, was associated with a 4-fold mortality increase. Bypass played a minor role in this series since only 6.8% of the patients underwent this operation. A nonfatal infarction recurred in 71 patients (22.1%) with an annual rate of 2.2%. Annual death rate after the first 2 years of follow-up was 3.9%, as in most recent reports on survival after myocardial infarction.