Düşük Riskli Miyokard İnfarktüslü Hastalarda 2. Ay Egzersiz Testinin Prognostik Önemi
Zerrin YİĞİT1, Deniz GÜZELSOY1, Vedat SANSOY1İstanbul Üniversitesi Kardiyoloji Enstitüsü, İstanbulÇalrşmamrzda akut miyokard infarktüsii (Mİ) sonrasr hastane içi dönemde kompleks ventrikiil aritmi. kalp yetersizliği veya erken post-Mİ mrgina görülmeyen 462 erkek, 44 kadm (yaş ortalamasr 51 .7±9.4), 264 ön duvar Mİ ve 242 arka duvar Mİ olan 506 Q dalgalr Mİ'lü hastada 2. ayda uygulanan semptomla srmrlr egzersiz testinin bir yriirk mortalite ve kardiyak olaylan öngörmede değeri araştırrldr. Egzersiz testinde 1 mm yatay ST çökmesi veya tipik angina pektor·is oluşmasr iskemi bulgusu olarak kabul edildi. Egzersiz süresinin 6 dk'dan düşük, egzersiz/e sisto/ik arter basmcr artışının (l:lSAB) 30 mmHg'dan az olmasr yüksek risk parametreleri olarak belirlendi. Ölüm, kararsrz angina pektoris, reinfarktiis, koroner anjiyoplasti (PTCA) ve oorto-koroner bay pass girişinıleri (ACBG) kardiyak olay olarak tanrnılandr. Tüm hastalar bir yri süre ile izlendi. Dokuz(% 1.8) hasta öldü. 92 (%18.2) hastada kardiyak olay gelişti. Yüksek kardiyak risk parametrelerinin ölüm ve kardiyak olayları öngörmedeki pozitif prediktif değerleri iskemi için %2, %27, egzersiz süresi için %4, %34 ve l:lSAB için %3, %23; negatif prediktif değerleri iskemi için %99, %89, egzersiz süresi için %99, %87, ASAB için %99, %87 bulundu. Üç parametre birlikte değerlendirildiğinde ise pozitif prediktif değer ölüm için %10'a, kardiyak olaylar için ise %81 'e yükseldi, negatif prediktif değer ölüm için %99 ve kardiyak olaylar için %98 olarak bulundu. Sonuç olarak, Mi sonrası 2. ayda yaprlan egzersiz testinde iskemi, düşük egzersiz kapasitesi, yetersiz SAB yanrtı gibi risk parametreleri bulunmayan hastalarda bir yıllık ölüm ve kardiyak olay riskinin düşük olduğuna ve bu hastalarda rutin koroner anjiyografı yapılmasma gerek olnıadrğrna karar verildi.
Anahtar Kelimeler: Miyokard infarktüsü, egzersiz testi, prognozPrognostic Significance of Maximal Exercise Testing After Uncomplicated Myocardial Infarction
Zerrin YİĞİT1, Deniz GÜZELSOY1, Vedat SANSOY1To investigate the prognostic s ignificance of maximal exerc ise tes ting two months after uncomplicated myocardial infaretion (Ml). 506 patients (462 men, 44 women, mean age 5 ı .7±9.4, 246 anterior and 242 inferior Ml) were followed up for one year. The exercise test criteria for ischemia were typical angina pectoris and or ST depression of 1 mm. Exercise time less than 6 minules and exercise-induced systolic blood pressure (SBP) increase Jess than 30 mmHg were other parameters for high risk. Cardiac events (CE) were defined as cardiac death, reinfarction, unstable angina pectoris, a coronary angioplasty or aorto-coronary by-pass surgery. During follow-up 9 patients (1.8 %) died and 92 (18.2 %) had a cardiac event. The positive predictive va1ues of ECG ischemia, exercise duration, and ASBP for death were found to be 2% 4% and 3%, respectively for coronary events, the positive predictive value of ECG ischemia, exercise duration and ~SBP were 27%, 34% and 23%, respectively. The negative predictive values of the same parameters were found to be 99% and 89%, 99% and 87%, and 99% and 87%, respectively. When all of the parameters were considered together, the positive and negative predictive values for death and coronary events were found to be 10% and 81%,99% and 98%, respectively. It is concluded that, after an uncomplicated myocardia1 infarction, patients without ischemia and with a good exercise capacity and systolic blood pressure response to exercise need not undergo routine coronary angiography. Key words: Myocardial infarction, exercise test, prognosisTo investigate the prognostic s ignificance of maximal exerc ise tes ting two months after uncomplicated myocardial infaretion (Ml). 506 patients (462 men, 44 women, mean age 5 ı .7±9.4, 246 anterior and 242 inferior Ml) were followed up for one year. The exercise test criteria for ischemia were typical angina pectoris and or ST depression of 1 mm. Exercise time less than 6 minules and exercise-induced systolic blood pressure (SBP) increase Jess than 30 mmHg were other parameters for high risk. Cardiac events (CE) were defined as cardiac death, reinfarction, unstable angina pectoris, a coronary angioplasty or aorto-coronary by-pass 133 Türk Kardiyol Dem Arş 1999:27: 132-135 surgery. During follow-up 9 patients (1.8 %) died and 92 (18.2 %) had a cardiac event. The positive predictive va1ues of ECG ischemia, exercise duration, and ASBP for death were found to be 2% 4% and 3%, respectively for coronary events, the positive predictive value of ECG ischemia, exercise duration and ~SBP were 27%, 34% and 23%, respectively. The negative predictive values of the same parameters were found to be 99% and 89%, 99% and 87%, and 99% and 87%, respectively. When all of the parameters were considered together, the positive and negative predictive values for death and coronary events were found to be 10% and 81%,99% and 98%, respectively. It is concluded that, after an uncomplicated myocardia1 infarction, patients without ischemia and with a good exercise capacity and systolic blood pressure response to exercise need not undergo routine coronary angiography.
Keywords: Myocardial infarction, exercise test, prognosis| ARAÇLAR |
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