Prevention

• myocardial perfusion imaging ^b
• echocardiography ^b
• symptom-limited ^c exercise tolerance test looking for ^b
  • limited exercise duration
  • impaired systolic blood pressure changes
  • impaired systolic blood pressure changes

Why?

• Patients who have symptom-limited tolerance tests compared with low-level tests are more likely to show signs of ischaemia. ^c
• Abnormal exercise tolerance tests slightly increase the risk of dying from heart disease. ^b
• ST-segment depression on exercise test increases the risk of recurrent myocardial infarction. ^a

Abnormal tress testing slightly increases the risk of dying from heart disease

Patient	Prognostic Factor	Outcome	CER	OR (95% CI)	NNF+ (95% CI)
myocardial infarction b	exercise ECG: ST depression >1mm independent	death from heart disease at months	4.4%	1.7 (1.2 to 2.5)	35 (17 to 120)
	exercise ECG: impaired systolic BP independent			4.0 (2.5 to 6.3)	9 (6 to 17)
	exercise ECG: limited exercise duration independent			4.0 (1.9 to 8.4)	9 (4 to 27)
	myocardial perfusion imaging; exercise testing: reversible perfusion defect independent			3.1 (1.6 to 4.6)	12 (8 to 41)
	Ventricular function; exercise stress: ejection fraction < 40% independent			3.2	12
	Ventricular function; exercise stress: ejection fraction change <5% independent			4.2	8
	Ventricular function; exercise stress: new dyssynergy independent			1.2	120
	Ventricular function; pharmacological stress: new dyssynergy independent			2.7 (1.4 to 5.2)	15 (7 to 60)