title: Actual clinical practice of exercise testing in consecutive patients after non-ST-elevation myocardial infarction: results of the acute coronary syndromes registry.
abstract: BACKGROUND
  Exercise testing has been advocated for risk stratification and determination of therapeutic strategies after acute myocardial infarction. Frequency and therapeutic impact of exercise testing after non-ST-elevation myocardial infarction (NSTEMI) in actual clinical practice, however, is not known.
  
  
  RESULTS
  From the German acute coronary syndrome (ACOS) registry patients with acute NSTEMI (n = 5281) were evaluated: 20.8% of patients (1097/5281) had predischarge exercise testing, and from these tests 33.5% (367/1097) were positive. The strongest predictors for renunciation of predischarge exercise testing were ejection fraction under 40%, age over 70 years and stroke history. In-hospital coronary angiographies or percutaneous coronary interventions were not associated with a lower rate of exercise testing. During 1-year follow-up all-cause mortality was 13.6% in patients without and 5.1% in patients with exercise test respectively (P < 0.0001). In patients with positive exercise test 1-year mortality was 6.5%, in patients with negative exercise test 4.4% (P = 0.13). During follow-up no significant difference was found in the rate of coronary revascularizations between patients either with positive or negative exercise tests. Furthermore, no significant difference was found in the rate of death and revascularizations comparing different groups of exercise capacity.
  
  
  CONCLUSIONS
  After NSTEMI in Germany the majority of patients do not get predischarge exercise testing, although this group appears to be of special risk for fatality during follow-up. Furthermore, in actual clinical practice, neither exercise induced signs of ischemia nor exercise capacity have a significant impact on the rate of revascularization procedures during follow-up.
authors.affiliation: Heart Center Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany. HarmWnbrgn@aol.com
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
authors.forename: Anselm
authors.initials: A
authors.lastname: Kai Gitt
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schiele
authors.forename: Claus
authors.initials: C
authors.lastname: Juenger
authors.forename: Tobias
authors.initials: T
authors.lastname: Heer
authors.forename: Martin
authors.initials: M
authors.lastname: Gottwik
authors.forename: Joachim
authors.initials: J
authors.lastname: Manthey
authors.forename: Albrecht
authors.initials: A
authors.lastname: Hempel
authors.forename: Kurt
authors.initials: K
authors.lastname: Bestehorn
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rauch
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005080:Exercise Test; D006801:Humans; D016015:Logistic Models; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012042:Registries; D012306:Risk; D012307:Risk Factors