Symptom-limited versus low level exercise testing before hospital discharge after myocardial infarction

Abstract

A symptom-limited exercise test performed before hospital discharge after uncomplicated myocardial infarction provides a significantly greater cardiovascular stress than does a low level test and is associated with an ischemic response nearly twice as frequently. The prognostic significance of a positive response at higher work loads has not been defined.

Exercise Standards for Testing and Training

“…However, the safety and the additive prognostic value from information obtained from the performance of symptom-limited protocols within days rather than weeks after MI has not yet been established. 55 …”

“…Symptom-limited protocols have an event rate that is 1.9 times that of submaximal tests, although the overall fatal event rate is quite low. 55,56 …”

“…These studies demonstrate that such testing yields ischemic responses nearly twice as often as submaximal tests and are a better estimate of peak functional capacity. 55 Thus, early symptom-limited tests have the potential to be more useful in activity prescription before discharge. However, the safety and the additive prognostic value from information obtained from the performance of symptom-limited protocols within days rather than weeks after MI has not yet been established.…”

Messung der kardiorespiratorischen Fitness in der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)

“…Maximale Belastungstests setzen daher die Anwesenheit eines qualifizierten Arztes sowie eine apparative Ausstattung mit Mehrkanal-EKG-Gerät, vollständige Notfallausrüs-tung und Defibrillator voraus [19,25]. Bei submaximalen Belastungstests ist das Zwischenfallrisiko bei Herzpatienten nur etwa halb so groß wie bei maximalen Belastungstests [23,26]. Da die Anforderungen an Ausstattung und Personal geringer sind [19] und die Testdauer kürzer ist, stellen submaximale Belastungstests eine kostengünstige Alternative zu maximalen Belastungstests dar; bei einer dennoch adäquaten Einschät-zung der kardiorespiratorischen Fitness [6].…”

Evaluation of the treadmill stress testing for risk stratification after acute myocardial infarction

“…Symptom-limited versus low level exercise testing -TIMI II trial, which established the possibility of evaluating patients after acute myocardial infarction through noninvasive management, used a low level exercise protocol 4,5,20 . In another study 27 , 202 patients with uncomplicated acute myocardial infarction, 115 of whom had received thrombolytic agents, underwent two treadmill stress tests on subsequent days and in an alternate way through randomization. One of the tests was interrupted at 5METS or 70% of the maximum frequency for the age, while the other was interrupted according to symptoms, electrocardiographic or physical examination changes.…”