THE INFLUENCE OF THROMBOLYTIC THERAPY ON THE PREDICTIVE VALUE OF EXERCISE TESTING 3 WEEKS AFTER ACUTE MYOCARDIAL-INFARCTION

Objectives. To evaluate the prognostic value of exercise testing perfo rmed soon after acute myocardial infarction (AMI) in patients treated with thrombolytic therapy. Design. A 1-year prospective follow-up of 1 85 subjects treated with thrombolytic therapy who survived AMI, and wh o performed exercise testing 3 weeks after AMI, These patients were co mpared 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. Mai n outcome measures. ST-segment deviations during exercise testing 3 we eks post-AMI were related to clinical outcome 1-year post-AMI and to t he administration of thrombolytic therapy during the acute phase of in farction. Results, In patients treated with thrombolytic therapy, the only exercise-test-related parameter predicting subsequent cardiac eve nts was ST-segment elevation. In contrast, patients not receiving thro mbolytic therapy and demonstrating ST-segment depression of greater th an or equal to 1 mm during exercise had more clinical cardiac events t han 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.