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European Heart Journal 1987 8(Supplement G):109-113; doi:10.1093/eurheartj/8.suppl_G.109
Copyright © 1987 by the European Society of Cardiology.
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© 1987 The European Society of Cardiology

Prognostic importance of exercise-induced ST-segment depression in patients with documented coronary artery disease

H. Gohlke, P. Betz and H. Roskamm

Rehabilitationszentrum für Herz- und Kreislaufkranke Bad Krozingen, F.R.G.

Address correspondence to: PD Dr. H. Gohlke, Rehabilitationszentrum für Herz- und Kreislaufkranke, D-7812 Bad Krozingen, FRG.

Exercise-induced ST-segment depression is a marker of impaired prognosis in patients with suspected or manifest CAD. Whether ST-segment depression remains of prognostic importance, after exercise tolerance and extent of CAD have been considered, is unknown.

We analysed the prognostic importance of exercise-induced ST-segment depression (>0.15 mV) in 1250 medically treated patients with angiographically determined CAD (mean follow-up after angiography 4.5 years). Based on exercise tolerance (supine bicycle ergometry) patients were divided into two groups: group A patients (n=677) with lower exercise tolerance (≤75 W) and group B patients (n=573) with better exercise tolerance (>75 W).

Group A patients had a lower 5-year survival rate than group B patients (81.5% versus 94%, P<0.00001). In group A, patients with ST-segment depression had a lower 5-year survival rate than patients without ST-segment depression (76% versus 85%, P=0.01).

In group B, patients with and without ST-segment depression had similar 5-year survival rates (90% versus 96%, P=0.11). Subgroup analysis of groups A and B according to number of diseased vessels and presence or absence of ST-segment depression revealed that exercise-induced ST-segment depression (>1.5 mV) was of additional prognostic importance only in patients with triple vessel disease. 5-year survival rates in group A with triple vessel disease were 71% with and 80% (P=0.057) without ST-segment depression. In group B 5-year survival was 80% with and 98% without ST-segment depression, (P<0.04). ST-segment depression did not influence prognosis in patients with single and double vessel disease.

After consideration of exercise tolerance and extent of CAD, exercise-induced ST-segment depression is of additional prognostic importance only in patients with triple vessel disease.

Key Words: ST-segment depression • exercise tolerance • coronary artery disease


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