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Aims: To evaluate the prognostic importance of pre- discharge maximal symptom- limited exercise testing(ET) following acute myocardial infarction(AMI) in the era of aggressive reperfusion. Methods and results: In the DANAMI- 2(the second DANish trial in AMI) study, patients with ST- elevation AMI(STEMI) were randomized to primary angioplasty(PCI) or fibrinolysis. Of 1462 patients discharged alive, 1164(79.6% ) performed an ET. Primary endpoint was a composite of death and re- infarction. Patients randomized to fibrinolysis developed ST- depression to a greater extent than patients randomized to primary PCI(21.7 vs. 15.3% , P=0.007). Multivariable predictors of death and re- infarction included age, gender, diabetes, previous stroke, anterior AMI, randomization to fibrinolysis, and exercise capacity[risk ratio(RR) 0.82(0.72- 0.93); P< 0.001]. ST- depression was predictive of the clinical outcome[RR 1.57(1.00- 2.48); P< 0.05] in multivariable analysis, but stratified according to treatment groups there was a significant association between ST- depression and outcome in the fibrinolysis group[RR 1.95(1.11- 3.44); P< 0.05], but not in the primary PCI group[RR 1.06(0.47- 2.36); P=ns]. However, the P- value for interaction was 0.15. Conclusion: Exercise testing after contemporary reperfusion therapies for STEMI confers important prognostic information. Exercise capacity is a strong prognostic predictor of death and re- infarction irrespective of treatment strategy, whereas the prognostic significance of ST- depression seems to be strongest in the fibrinolysis- treated patients.
Aims: To evaluate the prognostic importance of pre- discharge maximal symptom-limited exercise testing (ET) following acute myocardial infarction (AMI) in the era of aggressive reperfusion. Methods and results: In the DANAMI-2 (the second DANish trial in AMI Of 1462 patients discharged alive, 1164 (79.6%) performed an ET. Primary endpoint was a composite of death and re- intervention. Patients randomized to fibrinolysis developed ST-depression to a greater extent than patients randomized to primary PCI (21.7 vs. 15.3%, P = 0.007). Multivariable predictors of death and re- intervention include age, gender, diabetes, previous stroke, anterior AMI , randomization to fibrinolysis, and exercise capacity [risk ratio (RR) 0.82 (0.72- 0.93); P <0.001]. ST- depression was predictive of the clinical outcome [RR 1.57 (1.00- 2.48) analysis, but stratified according to treatme nt groups there was a significant association between ST-depression and outcome in the fibrinolysis group [RR 1.95 (1.11- 3.44); P <0.05], but not in the primary PCI group [RR 1.06 (0.47- 2.36); P = ns However, the P-value for interaction was 0.15. Conclusion: Exercise testing after contemporary reperfusion therapies for STEMI confers important prognostic information. Exercise capacity is a strong prognostic predictor of death and re- intervention irrespective of treatment strategy, while the prognostic significance of ST-depression seems to be strongest in the fibrinolysis- treated patients.