Early prognosis after thrombolysis: value of exercise radionuclide ventriculography performed on anti-ischaemic medication.

We examined the prognostic value of exercise radionuclide ventriculography (RNV) performed on anti-ischaemic medication following thrombolysis. Within 3 months of thrombolysis for first myocardial infarction, 31 medically treated patients with revascularisable but non-critical and minimally symptomatic coronary disease had left ventricular ejection fraction (LVEF) measured by first-pass exercise RNV. This was first performed off treatment and then repeated within 4 weeks on patients' regular medication. Follow-up at 12 months post-thrombolysis showed that 5 patients (Group I) had suffered significant recurrent symptoms (worsening angina requiring revascularisation in 3, unstable angina in 1, reinfarction in 1), but 26 remained well (Group II). Both groups were similar in age, post-thrombolytic severity of coronary disease, exercise LVEF whether off (39% vs 43%) or on medication (43% vs 44%), and change in LVEF with exercise ([symbol: see text]LVEF) off medication (-11% vs - 3%). However, on medication, there was a significant difference in mean [symbol: see text]LVEF between Groups I and II (-11% vs + 5%, P = 0.0008, 99% confidence interval = 4 to 26%). Thus, following thrombolysis, an abnormal [symbol: see text]LVEF despite anti-ischaemic medication may identify patients at risk of significant early recurrent ischaemia. Post-thrombolysis prognostic testing by exercise RNV may therefore be of greater value when performed on rather than off medication.