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[Evaluation of prognosis after Q wave myocardial infarction. Comparison of invasive and noninvasive diagnostic strategies].

The predictive value of several diagnostic strategies after myocardial infarction was assessed in 178 patients (mean age 55 +/- 9 years) treated medically after a primary Q wave myocardial infarction. Within 6 weeks of onset of symptoms the authors performed exercise stress test coupled with Thallium 201 scintigraphy, isotopic left ventriculography and conventional coronary angiography with ventriculography. The average left ventricular ejection fraction was 45 +/- 12%. Two non-invasive diagnostic strategies with and without results of scintigraphy and two invasive strategies with and without ventricular volumes were studied. The average follow-up period was 58 +/- 22 months. Sixteen cardiac deaths occurred. Multivariate Cox analysis showed that, in contrast to left ventricular volumes, coronary angiography did not provide additional prognostic value compared with the non-invasive model with Thallium scintigraphy and did not appear to be essential in terms of predictive value in this population. Moreover, the size of reversible defect on Thallium scintigraphy was an independent predictive factor of cardiac death and provided additional and independent prognostic information in the non-invasive and invasive strategies. Therefore, the reduction of residual ischaemia by coronary revascularisation could improve the long-term prognosis after myocardial infarction.