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European Heart Journal 2000 21(11):901-910; doi:10.1053/euhj.1999.1936
Copyright © 2000 by the European Society of Cardiology.
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Prognostic implications of results from exercise testing in patients with chronic stable angina pectoris treated with metoprolol or verapamil. A report from The Angina Prognosis Study In Stockholm (APSIS)

L Forslunda,f1, P Hjemdahlb, C Helda, I Björkandera, S.V Erikssona, U Brodinc and N Rehnqvistd

a Department of Medicine, Danderyd Hospital, Stockholm, Sweden
b Department of Clin Pharmacol, Karolinska Hospital, Stockholm, Sweden
c Department of Medical Information and Educational Development, Karolinska Institute, Stockholm, Sweden
d National Board of Health and Welfare, Stockholm, Sweden

revised September 2, 1999; accepted September 8, 1999

Abstract

Aims To evaluate the prognostic implications of results from exercise testing, and of antianginal treatment among patients with chronic stable angina pectoris.

Material and Methods Out of 809 patients in the Angina Prognosis Study In Stockholm (APSIS), 731 (511 men) performed evaluable exercise tests before and after 1 month on double-blind treatment with metoprolol or verapamil. During a median follow-up of 40 months, 32 patients suffered a cardiovascular death and 29 a non-fatal myocardial infarction.

Results Prognostic implications of results from exercise tests were assessed in a multivariate Cox model which included sex, previous myocardial infarction, hypertension and diabetes mellitus. Maximal ST-segment depression, especially if ≥2mm and occurring after exercise, as well as exercise duration independently predicted cardiovascular death. Similar results were obtained for the combined end-point of cardiovascular death+myocardial infarction. Among patients with a positive exercise test at baseline, verapamil reduced the maximal ST-depression more markedly than metoprolol (P<0·01). However, when the treatment given and treatment effects on ST-segment depression were added to the Cox model, no impact on prognosis could be detected for either cardiovascular death alone or combined with myocardial infarction. Anginal pain carried no prognostic information.

Conclusion Marked ST-segment depression during and after exercise, and a low exercise capacity independently predicted an adverse outcome in patients with stable angina pectoris, whereas anginal symptoms had no predictive value. Short-term treatment effects on ischaemia did not seem to influence prognosis. Post-exercise ischaemia should be examined carefully when evaluating patients with stable angina pectoris.

Key Words: Angina pectoris, exercise testing, ischaemia, prognosis

f1 Correspondence: Lennart Forslund MD, Department of Medicine, Trelleborg's Hospital, S-231 85 Trelleborg, Sweden.

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