DOES THROMBOLYSIS AFFECT THE PROGNOSTIC VALUE OF THE POST-INFARCT EXERCISE TEST

There has been some debate on usefulness of the exercise test in risk stratification after myocardial infarction in the thrombolytic era. Th is was assessed in 295 patients of whom 184 were treated with thrombol ysis. Each had an exercise test using a modified Naughton protocol wit hin 14 days of acute myocardial infarction. The tests were graded as h igh risk positive (112), low risk positive (83), or negative (100). Th ese gradings predicted use of multiple drug therapy (p = 0.05), severi ty of coronary artery disease (p < 0.01), and coronary artery bypass g rafting (p < 0.01). There was no influence on heart failure, recurrent myocardial infarction or death. This was independent of the use of th rombolytic therapy. The whole group had a good prognosis with a mortal ity of 2.4% after 56 weeks' follow-up. The exercise test is still a us eful screening test after myocardial infarction. In this study, there was a high negative predictive accuracy of 91% for any event. Its use is not altered by thrombolysis. The finding of a lack of influence of the exercise test on major events may be a reflection bf the current g ood prognosis after myocardial infarction and the prompt use of revasc ularisation.