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European Heart Journal 1987 8(8):861-869;
Copyright © 1987 by the European Society of Cardiology.
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© 1987 The European Society of Cardiology

Prognostic importance of early exercise testing in men with suspected unstable coronary artery disease

E. SWAHN, M. ARESKOG and L. WALLENTIN

Division of Cardiology, Department of Internal Medicine and Department of Clinical Physiology, University Hospital S-581 85 Linköping Sweden

Received 3 July 1986; revised 21 January 1987; .

Eva Swahn, M.D., Division of Cardiology, Department of Internal Medicine, University Hospital, S-581 85 Linköping Sweden.

In 276 men with suspected unstable coronary artery disease i.e. recurring chest pain of new onset, increasing symptoms of anginal chest pain in formerly stable angina pectoris or suspected non-Q-wave infarction, an exercise test was performed 2–7 days after admission. Coronary events i.e. cardiac death (N=4), Q-wave infarction (N=11) and coronary artery bypass grafting (N=34), were registered during one year follow-up. The indication for bypass grafting was incapacitating angina pectoris despite medication, and suitable coronary anatomy. Stepwise multiple regression analysis showed that S–T segment depression and limiting chest pain were the most important prognostic parameters regarding coronary events. In patients with S–T segment depression >0.1 mV or limiting chest pain (N=94) the occurrence of Q-wave myocardial infarction or cardiac death was 10.6% (N=10) compared to 2.8% (N=5) in patients without these criteria (N=182) (P<0.01). Coronary arterty bypass graft surgery was performed in 33% (N=31) of the group with S–T segment depression >0.1mV or limiting chest pain but in only 1.7% (N=3) of the other patients (P<0.001). Thus, in patients with suspected unstable coronary artery disease, whose symptoms and signs of ischaemia are stabilized by medication, an exercise test can safely be performed after a few days ambulation in the ward. The early exercise test provides important prognostic information regarding the risk for severe coronary events within the next year.

Key Words: Unstable angina pectoris, • exercise testing, • coronary artery disease, • mortality, • coronary artery bypass graft surgery.


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