Document Detail

Prognostic significance of double product and inadequate double product response to maximal symptom-limited exercise stress testing after myocardial infarction in 6296 patients treated with thrombolytic agents. GISSI-2 Investigators. Grupo Italiano per lo Studio della Sopravvivenza nell-Infarto Miocardico.
MedLine Citation:
PMID:  10047624     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The aim of this study was to evaluate the prognostic significance of the pressure-rate product (PRP) obtained during exercise stress testing and of its change from rest to maximal exercise (dPRP) in a population of survivors of acute myocardial infarction treated with thrombolytic agents. METHODS AND RESULTS: Survivors of acute myocardial infarction (n = 6251) from the GISSI-2 database, who underwent a maximal symptom-limited exercise test with either bicycle ergometer or treadmill, were followed up for 6 months. PRP and dPRP values were dichotomized (</=21,700 and >21,700, </=11, 600 and >11,600, respectively) and analyzed in a multivariate Cox model individually and simultaneously with other ergometric variables. Six-month mortality rate was 0.8% in the high PRP group and 2.0% in the low PRP group. Low PRP was an independent predictor of 6-month mortality rate (relative risk [RR] 1.97, 95% confidence interval [CI] 1.24 to 3.13). Patients with low dPRP had mortality rates higher than patients with high dPRP (2.1% vs 0.8%). At the multivariate analysis, low dPRP showed negative predictive value (RR 1.97, 95% CI 1.23 to 3.16). A further multivariate analysis was performed with PRP and dPRP, also adjusting for low work capacity, abnormal systolic blood pressure response to exercise, and symptomatic-induced ischemia. The results showed that low work capacity, low PRP, and symptomatic exercise-induced ischemia were still significantly associated with higher 6-month mortality rate (P =.04,.02, and.05; RR = 1.68, 1.71, and 1.78 respectively). CONCLUSIONS: PRP is a predictive index to assess prognosis in survivors of acute myocardial infarction treated with thrombolytic agents able to perform an exercise test after acute myocardial infarction, but its usefulness appears to be limited, considering that these patients were at low risk.
M Villella; A Villella; S Barlera; M G Franzosi; A P Maggioni
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  137     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-03-25     Completed Date:  1999-03-25     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  443-52     Citation Subset:  AIM; IM    
Ospedale "Casa Sollievo della Sofferenza" IRCCS, S Giovanni Rotondo, Milan, Italy.
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MeSH Terms
Analysis of Variance
Blood Pressure / physiology*
Confidence Intervals
Exercise Test*
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Heart Rate / physiology*
Multivariate Analysis
Myocardial Infarction / drug therapy*,  physiopathology
Myocardial Ischemia / etiology
Odds Ratio
Physical Exertion / physiology
Predictive Value of Tests
Proportional Hazards Models
Rest / physiology
Risk Factors
Survival Rate
Thrombolytic Therapy*
Work Capacity Evaluation
Reg. No./Substance:
0/Fibrinolytic Agents

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