Exercise testing for patients after myocardial infarction and coronary bypass surgery: emphasis on predischarge phase

Data from the preceding low-level exercise test studies have been compiled and are presented in Table II. The table is arranged according to groups of prognostic indicators for future coronary events or indicators for those patients with multivessel coronary artery disease. In summary, current studies demonstrate safety and predictive value in predischarge low-level exercise testing in patients after myocardial infarction. If the test reveals a positive S-T segment change or angina or both, the predictive value for future cardiac events is significant. In addition, a limited duration on the exercise test, a flat or falling blood pressure response, and the presence or absence of premature ventricular depolarizations add to this predictive value. A more sophisticated technique that employs radionuclide ventriculography may add to the sensitivity and specificity of these various tests but should be used selectively. Post-myocardial infarction patients who perform low-level exercise testing prior to discharge and demonstrate no exercise-induced abnormality from baseline may also harbor multivessel coronary disease, and this group of patients needs to be carefully followed. Testing at 3 weeks and 6 weeks after infarction may be beneficial in revealing additional clinical data. Less data are currently available on predischarge low-level exercise testing in patients with myocardial revascularization. However, these limited data support both feasibility and safety of low-level exercise testing in myocardial revascularization patients before discharge. Prognostic data with regard to low-level exercise testing for this group of patients should be forthcoming. Data from low-level exercise testing need to be incorporated during the in-hospital phase to eliminate unnecessary testing as the patient proceeds home and/or to medically supervised exercise programs. Proper therapeutic modalities based on these data should be included. In accord with this, it is imperative that the cardiac rehabilitation team or exercise testing laboratory correspond directly with the private physician regarding all clinical data and recommendations for discharge activity. Follow-up exercise testing for patients after myocardial infarction and coronary bypass surgery utilizes end points similar to those of predischarge low-level testing and therefore will not be discussed in detail. In general the patient should be able to achieve a higher heart rate or MET level in follow-up testing.(ABSTRACT TRUNCATED AT 400 WORDS)