The influence of thrombolytic therapy on the predictive value of exercise testing 3 weeks after acute myocardial infarction.
OBJECTIVE
To evaluate the prognostic value of exercise testing performed soon after acute myocardial infarction (AMI) in patients treated with thrombolytic therapy.


METHODS
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.


METHODS
Patients recovering from AMI, without medical contraindications to exercise testing performed 3 weeks after AMI.


METHODS
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).


CONCLUSIONS
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.
Department of Cardiology, Rambam Medical Centre, Faculty of Medicine, Haifa, Israel.
L
L
Abboud
J
J
Hir
I
I
Eisen
W
W
Markiewicz
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors