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

In 276 men with suspected unstable coronary artery disease i.e.recurring chest pain of new onset, increasing symptoms of anginalchest pain in formerly stable angina pectoris or suspected non-Q-waveinfarction, an exercise test was performed 2–7 days afteradmission. Coronary events i.e. cardiac death (N=4), Q-waveinfarction (N=11) and coronary artery bypass grafting (N=34),were registered during one year follow-up. The indication forbypass grafting was incapacitating angina pectoris despite medication,and suitable coronary anatomy. Stepwise multiple regressionanalysis showed that S–T segment depression and limitingchest pain were the most important prognostic parameters regardingcoronary events. In patients with S–T segment depression>0.1 mV or limiting chest pain (N=94) the occurrence of Q-wavemyocardial infarction or cardiac death was 10.6% (N=10) comparedto 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 orlimiting chest pain but in only 1.7% (N=3) of the other patients(P<0.001). Thus, in patients with suspected unstable coronaryartery disease, whose symptoms and signs of ischaemia are stabilizedby medication, an exercise test can safely be performed aftera few days ambulation in the ward. The early exercise test providesimportant prognostic information regarding the risk for severecoronary events within the next year.