ArticleBritish heart journal1993
Reassessment of treadmill stress testing for risk stratification in patients with acute myocardial infarction treated by thrombolysis.
Article in British heart journal, 1993. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The management of acute myocardial infarction: guidelines and audit standards. Report of a workshop of the Joint Audit Committee of the British Cardiac Society and the Royal College of Physicians.Journal of the Royal College of Physicians of LondonGuideline
- Impact of stress testing before percutaneous coronary intervention or medical management on outcomes of patients with persistent total occlusion after myocardial infarction: analysis from the occluded artery trial.American heart journal · 2009Trial
- Pre-discharge stress echocardiography and exercise ECG for risk stratification after uncomplicated acute myocardial infarction: results of the COSTAMI-II (cost of strategies after myocardial infarction) trial.Heart (British Cardiac Society) · 2005Trial
- A prospective study of long term prognosis in young myocardial infarction survivors: the prognostic value of angiography and exercise testing.Heart (British Cardiac Society) · 2003Article
- Prognostic value of symptom limited versus low level exercise stress test before discharge in patients with myocardial infarction treated with thrombolytics.Heart (British Cardiac Society) · 1999Article
- Prognostic value of predischarge radionuclide ventriculography at rest and exercise after acute myocardial infarction treated with thrombolytic therapy or primary coronary angioplasty. The Zwolle Myocardial Infarction Study Group.Clinical cardiology · 1998Article
- Adenosine technetium-99m sestamibi single-photon emission tomography for the assessment of jeopardized myocardium early after acute myocardial infarction. Paradoxical scintigraphic underestimation of jeopardized myocardium in patients with a severe infarct-related stenosis.European journal of nuclear medicine · 1997Article
- Value of thallium-201 imaging in detecting adverse cardiac events after myocardial infarction and thrombolysis: a follow up of 100 consecutive patients.BMJ (Clinical research ed.) · 1996Article
- Management of patients after their first myocardial infarction.BMJ (Clinical research ed.) · 1994Review
- Which patients should have exercise testing after myocardial infarction treated by thrombolysis?British heart journal · 1993Article
- Risk stratifying patients who survive an acute myocardial infarction.Journal of nuclear cardiology : official publication of the American Society of Nuclear CardiologyArticle
- Role of nuclear imaging after coronary revascularization.Journal of nuclear cardiology : official publication of the American Society of Nuclear CardiologyReview
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6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate the role of a treadmill stress test for identifying patients at risk of recurrent ischaemic events after acute myocardial infarction treated by thrombolysis.
backgroundThe 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.
methodsProspective 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.
resultsRecurrent 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.
conclusionsThe treadmill stress test is of limited value for identifying patients at risk of recurrent ischaemic events after acute myocardial infarction treated by thrombolysis.
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