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CLINICAL STUDY: STRESS TESTING

The exercise test that indicates a low risk of events

Differences in prognostic significance between patients with chronic stable angina and patients with unstable angina

^a Cardiology Unit, Hospital Santa María del Rosell, Murcia, Spain

Manuscript received March 7, 2001; revised manuscript received August 6, 2001, accepted August 24, 2001.

^* Reprint requests and correspondence: Dr. Rafael Florenciano, Historiador Torres Fontes,18; 4° E, 30011 Murcia, Spain.
r.florenciano{at}retemail.es

OBJECTIVES: The objective of this prospective study was to determine the differences in the prognostic significance of an exercise test (ET) that indicates a low risk of events (low-risk exercise test [LRET]) between patients with unstable angina (UA) and those with chronic stable angina (CSA).

BACKGROUND: It is not known whether the prognostic significance of an LRET is influenced by the disease; that is the reason for performing exercise testing.

METHODS: All patients not presenting with high-risk criteria were submitted to a prognostic ET. The ET was performed by patients with CSA and patients with primary UA stabilized with medical therapy. Medical therapy was planned for all patients. A combined end point was defined as cardiac death, nonfatal acute myocardial infarction or hospital admission for UA. Multivariate analysis was performed to determine the independent predictors of events.

RESULTS: Low-risk criteria were fulfilled by 105 patients with UA and 86 patients with CSA. The mean follow-up time was 347 ± 229 days. The event rate was higher in the UA group than in the CSA group (28% vs. 9%, p = 0.001). The CSA group showed worse ET results. Performance of ET by patients with UA was the principal predictor of events (odds ratio 4.2, p = 0.0005).

CONCLUSIONS: Among patients who underwent an LRET, those with UA had a rate of events significantly higher than that of patients with CSA, despite the worse results of ET in patients with CSA.

Abbreviations and Acronyms   CSA   chronic stable angina   ECG   electrocardiogram or electrocardiographic   ET   exercise test(ing)   LRET   low-risk exercise test   UA   unstable angina

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