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European Heart Journal 1988 9(4):418-426;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Non-invasive data provide independent prognostic information in patients with chest pain without previous myocardial infarction: findings in male patients who have had cardiac catheterization

R. J. LUWAERT, J. A. MELIN, C. R. BROHET, M. F. ROUSSEAU, R. PONLOT, A. M. D'HONDT, R. VANBUTSELE, A. ROBERT and J. M. R. DETRY

Division of Cardiology, Saint-Luc University Hospital B-1200 Brussels, Belgium

Received 8 April 1987; revised 25 August 1987; .

Address for correspondence: J. M. Detry, Division of Cardiology, Cliniques Universitaires Saint-Luc, 10, avenue Hippocrate, B 1200, Brussels, Belgium.

Abstract

From 1978 to 1985, 470 consecutive male patients with complaints of chest pain underwent a maximal exercise test with a thallium scan and coronary angiography (CA). Patients with a history of myocardial infarction (MI) were excluded. During the follow-up (from 12 to 96 months), 32 patients died and 30 had a non-fatal MI. Survival (SR) and event-free rates (EFR) were estimated by actuarial methods; the influence of non-invasive and invasive variables were examined in univariate and multivariate models using Cox analysis.

The five-year SR was 89% and EFR was 81%. Among historical data, age ( < 0.001), type of complaints ( <0.01) and pretest likelihood of CAD ( <0.01) were univariate predictors of EFR; by multivariate analysis, age was the only significant predictor ( <0.001). Most of the maximal-exercise (MEX) test data were good univariate predictors; by multivariate analysis, workload ( <0.001) and the maximal-exercise test score ( < 0001) were the significant predictors. From history and maximal-exercise test data, multivariate analysis indicated that the prognostic information was given by age (<0.05) and maximal-exercise test score ( <0.001). Among the invasive data, the number of diseased vessels ( <0.001) and ejection fraction were the predictors.

The combination of invasive and non-invasive data indicated that age, MEX score, number of diseased vessels and ejection fraction contributed significantly and independently to the estimation of prognosis. Among 242 patients with two or three diseased vessels, the prognosis was determined by the maximal workload ( < 0.01); ejection fraction ( < 0.07) was no longer significant.

Thus, in symptomatic patients without previous MI, the best estimation of prognosis is given by a combination of non-invasive and invasive data.

Key Words: Coronary artery disease • prognosis • exercise testing • thallium-201 scintigraphy


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