Exercise testing after acute myocardial infarction. How much? How soon?

Exercise testing shortly after acute myocardial infarction is considered safe and valuable for the determination of long-term prognosis. One point of discussion is whether a submaximal pre-discharge test or a maximal test at 6-8 weeks, which has a higher sensitivity for diagnosing multivessel disease should be preferred. The former is the authors' choice, since the submaximal predischarge test has excellent prognostic value for adverse effects, and because approximately 1.5% of patients who have a positive test have been noted to present with early ischemic deaths which ideally could have been prevented. In patients unable to exercise, mortality is about 19%. In these, the ejection fraction should be determined, and "stress" tests should be carried out administering dipyridamole or dobutamine intravenously and probably augmenting the diagnostic sensitivity of the test by radionuclide or echocardiographic evaluation.