European Heart Journal Advance Access originally published online on December 6, 2004
European Heart Journal 2005 26(2):119-127; doi:10.1093/eurheartj/ehi057
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European Heart Journal vol. 26 no. 2 © The European Society of Cardiology 2004; all rights reserved.
The prognostic value of pre-discharge exercise testing after myocardial infarction treated with either primary PCI or fibrinolysis: a DANAMI-2 sub-study
Department of Cardiology B, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
Received 10 July 2004; revised 29 September 2004; accepted 14 October 2004; online publish-ahead-of-print 6 December 2004.
* Corresponding author. Tel: +45 35 45 29 06; fax: +45 35 45 25 13. E-mail address: nvaleur{at}dadlnet.dk
See page 105 for the editorial comment on this article (doi:10.1093/eurheartj/ehi075)
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.
Key Words: ST-elevation acute myocardial infarction • Primary PCI • Exercise test • Prognosis • Reperfusion
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