Objectives: To evaluate the long-term predictive value
of exercise testing performed early after acute myocardial infarction
(AMI) in patients receiving thrombolytic therapy.
Design: Nonblinded prospective follow-up study.
Setting: Cardiac rehabilitation unit in a 900-bed
Subjects: Four hundred
forty-three patients allowed to perform exercise testing 3 weeks after
AMI were followed for a median of 75 months; 183 received IV
thrombolysis and 263 did not.
Results: Cardiac death
hazard ratios were significantly increased in the presence of reduced
physical working capacity on exertion, left ventricular dysfunction,
and ≥ 1-mm (but < 2-mm) ST-segment depression on exertion. In the
group receiving thrombolytic therapy, no patient with ≥ 2-mm
ST-segment depression on exercise died; this group was characterized by
a high rate of revascularization, whereas the group with ≥ 1-mm but< 2-mm ST-segment depression was not. No parameter related to
clinical or exercise testing predicted recurrent infarction in the
group receiving thrombolytic therapy. Among patients not receiving
thrombolysis, cardiac death was significantly related to ≥ 2-mm
ST-segment depression on exertion, to reduced physical working
capacity, and to the lack of revascularization during follow-up.
Conclusion: Exercise test-derived parameters have variable
value in predicting long-term survival of patients performing exercise
test after AMI depending on the following: (1) whether thrombolytic
therapy was given or not; (2) the degree of ST-segment depression
during exercise testing; and (3) the rate of