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[Ergometric test: prognostic significance in the pre-thrombolytic and thrombolytic period]
L Quattrini1, P F Tomassini, E Paciaroni
1Centro di Patologia Cardiovascolare, INRCA-Ancona.
Insights
Exercise testing remains valuable for predicting cardiac events after myocardial infarction. Despite advancements in treatment, its negative predictive ability is still reliable, comparable to pre-thrombolytic eras.
Area of Science:
- Cardiology
- Clinical Exercise Physiology
Context:
- Exercise testing was historically used to stratify risk post-myocardial infarction (MI).
- Thrombolytic therapy has raised questions about the continued utility of exercise testing.
- Left ventricular contractility is a key predictor identified through exercise testing.
Purpose:
- To evaluate the diagnostic and prognostic value of exercise testing after acute myocardial infarction in the context of modern therapies.
- To assess if the negative predictive ability of exercise testing has been compromised by thrombolytic therapy.
Summary:
- In the pre-thrombolytic era, exercise testing effectively identified low-risk (<1% 1-year event rate) and moderate-high risk (up to 17% 1-year event rate) populations post-MI.
- Markers of impaired left ventricular contractility were significant predictors.
- Despite concerns due to residual stenosis and plaque instability post-thrombolysis, current data suggest exercise testing retains adequate negative predictive ability, not inferior to the pre-thrombolytic era.
Impact:
- Exercise testing continues to be a useful tool for risk stratification in post-MI patients.
- Findings support the continued use of exercise testing in clinical practice for managing patients after acute myocardial infarction.
- Reaffirms the prognostic value of assessing left ventricular function through exercise capacity.
Abstract:
In the pre-thrombolytic era exercise testing showed the ability to identify a low-risk population with a 1 year event rate < 1% and a moderate-high risk group with an event rate up to 17% within 1 year after acute myocardial infarction. The most significant parameters are the markers of compromised left ventricular contractility. Since the introduction of thrombolytic therapy the negative predictive ability of exercise testing has been questioned, due to the frequent occurrence of residual coronary stenosis with atherosclerotic plaque characterized by marked instability, to the point that the usefulness of exercise testing has been challenged. Nevertheless the available information, albeit sparse, seems to confirm that the negative predictive ability of exercise testing is still adequate (good), and certainly not inferior to that in pre-thrombolytic era.