急性心筋梗塞後比較的早期のトレッドミル最大運動負荷試験の成績と予後の関係

Prognostic value of treadmill exercise testing early after acute myocardial infarction

　心筋梗塞後比較的早期のトレッドミル運動負荷試験の成績と冠動脈造影，左室造影所見を対比した研究は比較的多い。しかし急性心筋梗塞後の運動負荷試験の成績と予後の関係については欧米では散見されるものの本邦ではほとんど報告がない。今回我々は重篤な合併症のない梗塞後90日以内の比較的早期の患者を対象として施行したトレッドミル運動負荷試験の成績と，退院後経過観察中に認められた臨床所見との関係を検討したので報告する。

The prognostic value of symptom-limited tread-mill exercise testings performed early after acute myocardial infarction were studied in 124 patients. During 1 to 4 years follow up period, 36 of 59 patients (61%) with exercise induced ST depression (≧O.1mV) developed symptom of angina, as com-pared with 18 of 65 patients (28%) who had no ST depression (p<0.02). Moreover, 5 of 6 cardiac death and all of 6 patients received A-C bypass surgery showed exercise induced ST depression. A increase in systolic blood pressure less than 10mmHg during exercise occurred in 19 of 54 patients with post-infarction angina and 4 of 6 cardiac death. Exercise induced ST elevation (≧0.1mV) and ventricular ectopic activities failed to predict such coronary events in follow up period.

In conclusion, exercise induced ST depression and inadequate blood pressure response were highly predictive in post-infarction angina and death.