Pre-discharge stress echocardiography and exercise ECG for risk stratification after uncomplicated acute myocardial infarction: results of the COSTAMI-II (cost of strategies after myocardial infarction) trial
| Autor: | Alessandro Desideri, Lauro Cortigiani, Giuseppe Trocino, Dario Gregori, Leopoldo Celegon, Riccardo Bigi, Jeroen J. Bax, Eugenio Picano, Costantino Astarita, Paolo M. Fioretti, S Pirelli, J Velasco |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Heart disease Cost-Benefit Analysis Myocardial Infarction Infarction Physical exercise Cardiovascular Medicine Risk Assessment Electrocardiography Risk Factors Internal medicine Myocardial Revascularization medicine Stress Echocardiography Humans Prospective Studies cardiovascular diseases Myocardial infarction Risk factor Exercise physiology Exercise Aged business.industry Unstable angina Middle Aged Prognosis medicine.disease Patient Discharge Europe Quality of Life Physical therapy Cardiology Female Cardiology and Cardiovascular Medicine business Echocardiography Stress |
| Zdroj: | Heart. 91:146-151 |
| ISSN: | 1355-6037 |
| DOI: | 10.1136/hrt.2003.026849 |
| Popis: | Objective: To compare in a prospective, randomised, multicentre trial the relative merits of pre-discharge exercise ECG and early pharmacological stress echocardiography concerning risk stratification and costs of treating patients with uncomplicated acute myocardial infarction. Design: 262 patients from six participating centres with a recent uncomplicated myocardial infarction were randomly assigned to early (day 3–5) pharmacological stress echocardiography (n = 132) or conventional pre-discharge (day 7–9) maximum symptom limited exercise ECG (n = 130). Results: No complication occurred during either stress echocardiography or exercise ECG. At one year follow up there were 26 events (1 death, 5 non-fatal reinfarctions, 20 patients with unstable angina requiring hospitalisation) in patients randomly assigned to early stress echocardiography and 18 events (2 reinfarctions, 16 unstable angina requiring hospitalisation) in the group randomly assigned to exercise ECG (not significant). The negative predictive value was 92% for stress echocardiography and 88% for exercise ECG (not significant). Total costs of the two strategies were similar (not significant). Conclusion: Early pharmacological stress echocardiography and conventional pre-discharge symptom limited exercise ECG have similar clinical outcome and costs after uncomplicated infarction. Early pharmacological stress echocardiography should be considered a valid alternative even for patients with interpretable baseline ECG who can exercise. |
| Databáze: | OpenAIRE |
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