Prognostic Value of Limited Exercise Testing before Hospital Discharge Following Myocardial Infarction

Abstract

In-hospital mortality following myocardial infarction usually results from the destruction of large quantities of left ventricular myocardium and is expressed clinically as acute congestive heart failure or cardiogenic shock [1, 2]. In contrast, most deaths following hospital discharge are caused by ventricular arrhythmias and occur suddenly [3]; 10% (22/205) of a consecutive series of myocardial infarction patients discharged from our coronary care unit died within one year, most suddenly. Potentially beneficial therapeutic interventions such as intensive antiarrhythmic drug therapy or coronary artery bypass surgery are not innocuous; to apply them indiscriminately to all survivors of myocardial infarction would not be an optimal strategy since most patients would do well without such treatment. However, if a subgroup of myocardial infarction survivors at high risk for sudden death could be precisely identified at the time of hospital discharge, it would be logical to direct aggressive treatment toward them.