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ARTICLE

Feasibility and safety of early exercise testing using the Bruce protocol after acute myocardial infarction

^a Division of Cardiac Sciences, Grey Nuns Hospital, Edmonton, Alberta, Canada

Manuscript received June 7, 1999; revised manuscript received November 9, 1999, accepted December 17, 1999.

Reprint requests and correspondence: Dr. M.P.J. Senaratne, Associate Clinical Professor, Department of Medicine, University of Alberta, Division of Cardiology, Director of Coronary Care Unit, Grey Nuns Hospital, 1100 Youville Drive West, Edmonton, Alberta, Canada, T6L 5X8
mano{at}ibm.net

OBJECTIVES

To assess the feasibility and safety of exercise testing (ET) using a Bruce protocol (BPR) within three days of an acute myocardial infarction (AMI) with the data obtained from a prospectively managed database.

BACKGROUND

Exercise testing after AMI is usually done between days 4 and 6 and often using a "low-level" protocol. Earlier testing with BPR may allow for efficient triage.

METHODS

Patients were considered for early ET when off intravenous nitroglycerine with no rest angina, uncontrolled cardiac failure or arrhythmias.

RESULTS

Of 300 consecutive AMI patients who underwent an ET, 216 (72.0%; M = 163, F = 53; age mean 59 ± 0.8 SEM, range 34 to 83 years) had ET within three days of admission. There were 124 (57%) negative, 56 (26%) positive and 36 (17%) indeterminate tests. The maximum heart rate achieved was 116 ± 1 beats/min (range 64 to 163), which was 72.2 ± 0.8% of predicted maximum (86.6% on beta-adrenergic blocking agents at ET; exercise duration = 6.7 ± 0.2 min). Reasons for termination: maximum effort—89 (41%); low-level test target (stage III/IV of BPR)—63 (29%); positive ST segment change—19 (9%); severe chest pain—12 (5.5%); reaching 90% predicted maximum heart rate—6 (3%); nonsustained ventricular tachycardia—1 (0.5%); other—26 (12%). Fourteen (6.5%) patients had minor complications (i.e., drop in systolic pressure, chest pain >5 min) with no cardiac arrests, AMIs or deaths. After the ET, 87 (40%) patients were discharged the same day, 73 (34%) the next day.

CONCLUSIONS

The majority of ETs after an AMI can be done using the Bruce protocol within three days of admission with a very low incidence of complications. This can lead to early triage and potential cost savings.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BPR = Bruce protocol   CABGP = coronary artery bypass surgery group   CAGP = coronary angiography/angioplasty group   CK-MB = creatine kinase isoenzyme–myocardial band   CICU = coronary/intermediate care unit   DECGP = deceased group   ECG = electrocardiogram   EETGP = early exercise test group   ET = exercise test/testing   LETGP = late exercise test group   NETGP = no exercise test group   URV = unscheduled return visits

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