The principles of pre-discharge EST
This concept came about 20 years ago (1980s) to risk stratify patients following ACS to triage early coronary angiogram and revascualrisation. Generally patients are discharged by 5-7 days after an MI (May be 3-5 days in some hospitals) . Doing an exercise stress test early within 2 weeks has not been very popular with many cardiologist even though it was recommended by many guidelines.The type of stress recommended here , is heart rate limited sub maximal 70% of THR (Usually around 140 /mt ) is performed . This is due fear of precipitation another ACS.
Still, there are definite advantages for pre-discharge EST .It help us identify high risk subsets of STEMI and reduce the intermediate term mortality .More importantly it gives us an opportunity to exclude inappropriate revascualriations even without an angiogram . (The well known coronary dogma ie if a post STEMI patient performs > 10 METS , his heart carries little risk for future events still holds good !)
With the advent of liberal usage of CAG and improved techniques of revascularistion , most patients directly undergo pre-discharge CAG rather than EST !
Does any cardiologist have guts to do a pre- discharge EST after a successful primary PCI ?