Uncomplicated non-Q wave myocardial infarction: long-term prognosis with a conservative echo-stress guided management strategy.

Background: Whether an invasive or a conservative strategy should form the basis of an optimal management strategy for non-Q wave myocardial infarction is at present still subject of debate. We reported our observational experience with the long-term follow-up of patients with a first uncomplicated non-Q wave myocardial infarction and submitted to a conservative treatment strategy based on the in-hospital stress echocardiography and treadmill exercise.

Methods: We studied 134 consecutive patients admitted for a first uncomplicated non-Q wave myocardial infarction between 1991 and 1994. All patients were submitted to a dipyridamole echocardiography test (DET) between 5-7 days after admission and to a treadmill test before discharge. Coronary angiography and myocardial revascularization (coronary angioplasty or coronary artery bypass grafting) were performed according to the outcomes of the stress echo and treadmill test.

Results: The early and delayed follow-up results were quite good: 2.9% early hard events, 15% delayed hard events. DET negativity identified patients with a lower risk of both spontaneous and hard events. Multivariate analysis indicated the DET as the only predictive variable of spontaneous events within 1 year (p = 0.0001), of delayed spontaneous events (p = 0.0001) and of delayed hard events (p = 0.05).

Conclusions: In this study, revascularization procedures performed on the basis of stress echo result in good short- and long-term outcomes in stabilized uncomplicated non-Q wave myocardial infarction. The patients with a negative DET had a very low rate of events. DET positivity identifies a higher risk group of patients, whatever treatment they subsequently undergo.