Symptom-limited versus low level exercise testing before hospital discharge after myocardial infarction
| Autor: | Philippe Colles, Jules Y.T. Lam, Martin Juneau, David D. Waters, Guy B. Pelletier, Pierre de Guise, Pierre Théroux |
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| Rok vydání: | 1992 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Myocardial Infarction Infarction Blood Pressure Physical exercise Angina Pectoris Electrocardiography Internal medicine Heart rate medicine Humans ST segment Thrombolytic Therapy Myocardial infarction Exercise ST depression medicine.diagnostic_test business.industry Middle Aged Prognosis medicine.disease Patient Discharge Surgery Evaluation Studies as Topic Exercise Test Cardiology Female Myocardial infarction diagnosis medicine.symptom business Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of the American College of Cardiology. 20(4):927-933 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/0735-1097(92)90195-s |
| Popis: | This study was undertaken to compare a low level and a symptom-limited test performed before hospital discharge after an uncomplicated myocardial infarction.Exercise testing after myocardial infarction provides useful prognostic information. Usually either a low level test is performed before hospital discharge or a symptom-limited test is performed at 3 weeks.The study group comprised 202 patients with an uncomplicated myocardial infarction; 58 patients had a non-Q wave infarction and 115 patients had received thrombolytic therapy. Both a low level and a symptom-limited exercise test were performed in 200 of the 202 study patients in randomized order on consecutive days, a mean of 7.4 +/- 2.3 days after infarction.The symptom-limited test required a considerably greater effort than the low level test: exercise duration was 554 +/- 209 versus 389 +/- 125 s (p less than 0.0001), and peak work load was 5.7 +/- 1.8 versus 4.2 +/- 1.1 METs (p less than 0.0001). The peak heart rate was higher during the symptom-limited test (121 +/- 20 vs. 108 +/- 14 beats/min, p less than 0.0001), as was the rate-pressure product. The number of patients who developed ST segment depression greater than or equal to 1 mm increased from 56 during the low level test to 89 during the symptom-limited test (p less than 0.0001). ST segment depression greater than or equal to 2 mm occurred in 22 patients during the low level test and in 41 patients during the symptom-limited test, an 86% increase (p less than 0.0001). The number of patients with either angina or ST depression greater than or equal to 1 mm increased from 66 to 105 (p less than 0.0001) with the symptom-limited test. Exercise test results were similar for patients with a Q wave or a non-Q wave infarction. Exercise duration was longer and exercise-induced ST depression less frequent in patients who had received thrombolytic therapy.A symptom-limited exercise test performed before hospital discharge after uncomplicated myocardial infarction provides a significantly greater cardiovascular stress than does a low level test and is associated with an ischemic response nearly twice as frequently. The prognostic significance of a positive response at higher work loads has not been defined. |
| Databáze: | OpenAIRE |
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