Schatting van het overlijdensrisico in het eerste jaar na een hartinfarct; de waarde van klinisch onderzoek, inspanningsonderzoek, radionuclide-angiografie en 24-uurs-elektrocardiografie

- The value of clinical variables, symptom-limited bicycle stress testing, radionuclide ventriculography and 24-hour electrocardiography to predict one-year survival was assessed in 213 hospital survivors of myocardial infarction. During follow-up 12 patients died (6). A history of previous mnyocardial infarction and heart failure were the strongest clinical predictors of poor survival. Similarly a low ejection fraction (< 40) and a poor blood pressure rise during stres testing (< 30 mmHg) identified a high risk group. Stress test-induced angina and ST depression as well as ventricular arrhythmias from 24-hour electrocardiography were not predictive of survival.

We recommend that a pre-discharge stress test should routinely complement the clinical evaluation, since it provides prognostic information and also provides information on physical capacity, arrhythmias and myocardial ischaemia. A routine radionuclide ventriculography, 24-hour ambulatory electrocardiography or coronary arteriography are not warranted in low risk patients, identified by clinical and stress test results.