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European Heart Journal 1992 13(1):33-38;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Effect of thrombolytic therapy on exercise response during early recovery from acute myocardial infarction: A placebo controlled study

J. H. SVENDSEN*,{dagger},, J. K. MADSEN{dagger}, K. I. SAUNAMÄKI*, P. GRANDE{dagger}, F. PEDERSEN{dagger}, P. CLEMMENSEN*,{dagger}, C. HÆDERSDAL* and J. GRANBORG{dagger}

*Department of Cardiology, Gentofte Hospital Denmark
{dagger}Department of Medicine B, Division of Cardiology, Rigshospitalet, University of Copenhagen Denmark

Received 10 July 1990; revised 15 January 1991; .

Correspondence Jesper Hastrup Svendsen, MD, Department of Medicine B, 2142, Rigshospitalet, University of Copenhagen. 9 Blegdamsvej. DK.2100 Copenhagen Ø, Denmark

Abstract

Several studies have shown that infarct size is reduced following thrombolytic treatment in patients with acute myocardial infarction. Exercise test variables, such as an impaired heart rate response during exercise, are known to be related to left ventricular function and patient prognosis following acute myocardial infarction. The present study was performed to compare exercise test variables in acute myocardial infarction patients following either intravenous thrombolysis or placebo. Symptom-limited bicycle ergometer tests, carried out 1–2 weeks from the infarction, were performed in 85 patients randomized to intravenous streptokinase (N=41) or placebo (N=44) given within 12hfrom onset of symptoms. At rest heart rate, systolic blood pressure and rate-pressure product were similar in the two groups. At maximum workload the streptokinase treated patients had a higher median maximal heart rate than controls (136 vs. 126 b.min–1. P <0.01) but only a trend towards higher systolic blood pressure was seen (175 vs. 163 mmHg. P = 0.09). Rate-pressure product at maximal exercise was 23620 vs. 20 100 mmHg b min–1 respectively, (P <0.01). Total exercise time, ST-segment deviation, occurrence of angina pectoris and left ventricular ejection fraction were similar in the two groups. The trend towards an increased heart rate at maximum workload in streptokmnase-treated patients was seen at all levels of left ventricular ejection fraction, and at all levels of exercise capacity. In conclusion: patients treated with intravenous streptokinase for acute myocardial infarction reach both higher heart rates and rate-pressure products at maximum workload than their controls thus indicating that the beneficial effects of thrombolysis after acute myocardial infarction are reflected in an improved heart rate response during exercise.

Key Words: Thrombolysis • streptokinase • acute myocardial infarction • exercise test • heart rate


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