Early exercise testing after coronary care for suspected unstable coronary artery disease -- safety and diagnostic value

The safety of and the diagnostic information provided by a predischargeexercise test performed 2-7 days after admission to the coronarycare unit (CCU) was evaluated in 400 patients less than 65 yearsof age with suspected unstable coronary artery disease, i.e.probable or definite non-transmural myocardial infarction, progressiveangina pectoris or recurring chest pain of recent onset (‘newchest pain’). No serious complications occurred. Signsof ischaemia during exercise tests were more common in olderthan in younger men and more often found in subjects with thanwithout pathological findings in resting ECGs in the CCU. Above45 years of age, more than half of the men with progressiveangina or non-transmural MI had SI depression 2 mm and/or limitingchest pain, whereas men less than 45 years of age had a 10–25%incidence of corresponding findings in the test. In women above55 years with progressive angina or non-transmural MI, 30–35%had ST depression and/or limiting chest pain at the test while20–30% of women below 55 years of age had similar findingsat the test. Beta-adrenoceptor blockade was used by half ofthe patients but did not seem to conceal signs of severe ischaemia.Thus a predischarge exercise test can be performed safely inpatients with suspected unstable coronary artery disease inorder to support or reduce the suspicion of severe disease.