Incidence and prognostic significance of symptomatic and asymptomatic exercise-induced ischemia in patients with recent myocardial infarction

To determine the incidence and the significance of anginal chest pain during abnormal exercise testing (↙ S-T ≥ 0.1 mV) in patients with recent myocardial infarction we reviewed a series of 353 patients who underwent maximal bicycle exercise stress 4-8 weeks following acute myocardial infarction. Of the 353 patients, 26 had ischemic ECG changes and chest pain (group A); 85 patients had ischemic ECG changes but no chest pain (group B). The two groups differ significantly only in the frequency of a history of typical angina pectoris more than 6 months prior to acute myocardial infarction (group A 42.3% vs. group B 15.2%, p <0.01). Typical chest pain is more frequent in anterior versus inferior myocardial infarction (50 vs. 14.4%. p <0.001). The patients were followed up for 28.8 ± 8.7 months with clinical and exercise testing controls. The incidence of exertional angina during the follow-up was significantly more frequent in group A patients than in group B patients (80.7 vs. 24.7%, p <0.001). Unstable angina pectoris was more frequent in group A (34.6 vs. 11.8%, p <0.01). There was no statistically significant difference in mortality (group A 3.8% vs. group B 5.9%) and cardiac events (group A 3.8% vs. group B 5.9%) between the two groups. Thus, we concluded that the occurrence of anginal pain associated with S-T segment depression during exercise testing does not increase the prognostic risk.