The influence of thrombolytic therapy on the predictive value of exercise testing 3 weeks after acute myocardial infarction.

Abstract

OBJECTIVES: To evaluate the prognostic value of exercise testing performed soon after acute myocardial infarction (AMI) in patients treated with thrombolytic therapy. DESIGN: A 1-year prospective follow-up of 185 subjects treated with thrombolytic therapy who survived AMI, and who performed exercise testing 3 weeks after AMI. These patients were compared with 272 patients not receiving thrombolytic therapy during the same period. SUBJECTS: Patients recovering from AMI, without medical contraindications to exercise testing performed 3 weeks after AMI. MAIN OUTCOME MEASURES: ST-segment deviations during exercise testing 3 weeks post-AMI were related to clinical outcome 1-year post-AMI and to the administration of thrombolytic therapy during the acute phase of infarction. RESULTS: In patients treated with thrombolytic therapy, the only exercise-test-related parameter predicting subsequent cardiac events was ST-segment elevation. In contrast, patients not receiving thrombolytic therapy and demonstrating ST-segment depression of > or = 1 mm during exercise had more clinical cardiac events than those without this finding (12.3 vs. 3.9%; P < 0.05). CONCLUSION: This study casts doubt on the ability of exercise testing to select a high-risk population requiring early intervention to prevent recurrent coronary events after thrombolysis for AMI.