Usefulness of early exercise test after anterior infarction in the diagnosis of multivessel disease

OBJECTIVE: The aim of the present study was to determine the reliability of early exercise test to detect multivessel disease in survivors of an uncomplicated first anterior Q-wave myocardial infarction. METHODS: Among 100 consecutive patients 64 (aged 55 +/- 10 years) were included in the study. Thirty-four patients (53.1%) received thrombolytic therapy and this was considered successful, by means of non-invasive criteria, in 24 patients (37.5%). A standard symptom-limited exercise test, 11-15 days after myocardial infarction, and coronary arteriography, < 72 hours later, were performed in all patients. RESULTS: On exercise test 6 (9.3%) patients developed significant ST segment depression, 48 (75%) significant ST segment elevation, 5 (7.8%) ST depression in inferior leads together with ST elevation in anterior leads and 3 (4.6%) angina. Of the 18 patients with multivessel disease 5 (27.8%) developed ST depression, 10 (55.5%) ST elevation, 1 (5.5%) ST depression in inferior leads together with ST elevation in anterior leads and 1 (5.5%) angina. CONCLUSIONS: Our study indicates that ST depression in a symptom-limited exercise test performed early after an anterior Q-wave acute myocardial infarction is unusual and has low sensitivity (27.8%) to detect multivessel disease. ST elevation is the more common finding in this test (75%) and has no relation with the severity of CAD.