Prognostic value of exercise testing

We thank Dr Rønnevik for his comments on our article. Early works, such as the one published by Rønnevik and Von der Lippe are very valuable because they alert us to the real value of exercise testing. One of the main conclusions of the study of Rønnevik et al., namely that work capacity is associated with poor outcome in patients suspected of having myocardial infarction, fits well with our results and has been illustrated by the early meta-analysis, as pointed out by Ashley and Froelicher. Furthermore, the weak prognostic value of the presence of ischaemia during the test has been assessed both pre and post the thrombolytic era. Our study, of a large unselected population with confirmed myocardial infarction, adds to current knowledge demonstrating that prognostic associations are present after 15 years follow-up. Similar to the cohort followed by Rønnevik et al., the inability to perform the test is an even stronger predictor of poor outcome than information obtained during the test. In our opinion it is worth highlighting the poor prognosis of patients unable to perform an exercise test shortly after a myocardial infarction so that more can be done to improve and prolong their prognosis.