What is the safety of treadmill stress testing following acute myocardial infarction (MI)?

Updated: Nov 21, 2018
  • Author: David Akinpelu, MD, FACP; Chief Editor: Eric H Yang, MD  more...
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Answer

Current guidelines for the treatment of patients with acute MI include medical therapy, thrombolytic agents, and coronary revascularization. These interventions have led to a marked improvement in prognosis for post-MI patients, particularly those who have been treated with reperfusion, and mortality has been low among patients who have received thrombolytic agents or direct angioplasty.

Patients who are unable to perform an exercise test have a much higher rate of adverse events than those who are able to perform an exercise test. Symptomatic ischemic ST depression with exercise testing after thrombolytic therapy increases the risk of cardiac mortality 2-fold, but the absolute risk rate remains low (1.7% at 6 months).

Exercise testing after MI is generally safe. Submaximal testing can be performed at 4-7 days, and a symptom-limited test can be performed 3-6 weeks later. Some experts feel that symptom-limited tests can be conducted early after discharge, at approximately 14-21 days.

Exercise testing is useful in activity counseling after discharge from the hospital, and it is also an important tool in exercise training, as part of comprehensive cardiac rehabilitation for assessing the patient’s response to the exercise training program.


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