Early exercise stress testing is safe after primary percutaneous coronary intervention

Abstract

Background: The optimal timing of exercise stress testing post primary percutaneous coronary intervention is uncertain with anecdotal evidence suggesting an increased risk of acute myocardial infarction and/or death if performed too early. This has translated into a delayed return to normal life activities following an acute myocardial infarction resulting in an increase in socio-economic burden. Aims: We hypothesize that early (within 7 days of primary percutaneous coronary intervention) exercise stress testing is safe. Methods: A prospective study of consecutive patients enrolled into the Cardiac Rehabilitation Program at a tertiary referral centre that underwent primary percutaneous coronary intervention, and who were able to perform a treadmill stress test were recruited. Timing of exercise stress testing was within 7 days post primary percutaneous coronary intervention and outcomes of death, acute myocardial infarction and other major adverse cardiac event were assessed 24 hours post exercise stress testing. Results: Recruited patients (n=230) aged between 29 and 78 (mean age 56 ± 10 years) with 191 being males (83%) and 39 being females (17%). While 28 patients had a positive stress test (12.2%), there were no deaths, acute myocardial infarction or any other major adverse cardiac event within 24 hours of performing the exercise stress testing. Mean METS achieved were 8.1 ± 2.3. Conclusions: Early exercise stress testing after primary percutaneous coronary intervention appears safe.

Reliability and Validity of a Self-paced Cardiopulmonary Exercise Test in Post-MI Patients

“…There were no adverse events reported for the current study, providing support for the current evidence base that maximal exercise testing is a safe procedure to perform on cardiac patients [6,27,46].…”

“…Other studies have reported "good" test-retest reliability (CV for V O 2peak = 3.5-6.9 %) during cycling MIE tests in patients with various respiratory conditions [14,31,37]. CV's from previous research [12,22,27,32] investigating the use of traditional protocols are lower than those from the post-MI group of the current study. However, it is difficult to make direct comparisons between studies as different patient populations were used.…”

The utility of personal activity trackers (Fitbit Charge 2) on exercise capacity in patients post acute coronary syndrome [UP-STEP ACS Trial]: a randomised controlled trial protocol

“…The benefits of exercise on general health and in particular patients with coronary artery disease is well documented, however there remain many challenges in translating this into patient adherence. Near maximal exercise testing has been shown to be safe in patients post uncomplicated myocardial infarction in the days prior to discharge, and therefore early introduction of exercise should be strongly encouraged [ 48 – 50 ].…”

“…Some studies have suggested that strenuous activity is associated with increased risk of cardiac death or complications [ 47 ]. However, recent data suggests that near maximal intensity exercise in patients in the week of and thereafter following an uncomplicated acute coronary syndrome is safe [ 48 , 49 ].…”

Evaluation of Risk in Research must be Judged on Evidence, not Personal Opinion

“…Indeed, exercise testing is well established as a means of detecting ischaemic heart disease in untreated patients, and determining need for surgery and its type. In this regard, maximal exercise testing is deemed safe with cardiac patients [1], within 7 days of PCI [4], and even on the day of, or after stenting [7]. There is also evidence demonstrating maximal self-paced testing to be safe in clinical patients [2].…”