摘要
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) 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.
