Prognostic value of electrocardiogram exercise testing for risk stratification in asymptomatic coronary artery
Sara L Guerreiro1, Jorge M Ferreira, João M Calqueiro
1Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal.
Insights
Electrocardiogram exercise testing (EET) effectively predicts cardiovascular events in asymptomatic coronary artery disease (CAD) patients. The Duke Treadmill Score (DTS) and FIT score are valuable prognostic tools for risk stratification in this population.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Tools
Background:
- Electrocardiogram exercise testing (EET) variables predict cardiovascular events in general and CAD populations.
- Limited studies have assessed EET's prognostic value in asymptomatic coronary artery disease (CAD) patients.
Purpose of the Study:
- To evaluate the prognostic value of EET in asymptomatic CAD patients.
- To determine the predictive capability of various EET variables and exercise scores for cardiovascular events.
Main Methods:
- Retrospective single-center analysis of asymptomatic CAD patients undergoing EET.
- Evaluation of EET variables and three exercise scores: Duke Treadmill Score (DTS), Morise score, and FIT score.
- Primary endpoint: combined incidence of myocardial infarction (MI), revascularization, and all-cause death.
Main Results:
- The Duke Treadmill Score (DTS) and FIT score independently predicted the primary endpoint in asymptomatic CAD patients.
- DTS predicted MI or revascularization, while FIT predicted all-cause death.
- The Morise score did not show independent predictive power for the primary endpoint.
Conclusions:
- FIT and DTS demonstrated significant value for risk prediction in asymptomatic CAD.
- EET serves as a valid clinical follow-up tool for patients with asymptomatic CAD.
Background:
Several variables of electrocardiogram exercise testing (EET) predict cardiovascular events in the general population and in patients with coronary artery disease (CAD). However, most of the studies have not included patients with asymptomatic CAD. The aim of this study was to evaluate the prognostic value of EET in asymptomatic CAD patients.
Patients And Methods:
We carried out a retrospective single-center analysis including all patients with asymptomatic CAD documented by angiography who underwent EET from January 2010 to December 2013. A number of EET variables and three exercise scores [Duke Treadmill Score (DTS), Morise score, and FIT score] were analyzed. The primary endpoint was the combined incidence of myocardial infarction (MI), myocardial revascularization, and death from any cause during follow-up.
Results:
A total of 306 patients were included (mean age was 65±10 years, 61% had previous MI, and the median exercise capacity was 9.4±2.7 metabolic equivalent of task). The primary endpoint occurred in 15.7% of patients during 3.3 years of follow-up. The DTS and FIT were independent predictors of the primary endpoint unlike the Morise score (DTS: hazard ratio=0.91, 95% confidence interval: 0.85-0.99, P=0.018; FIT score: 0.99, 0.98-0.996, P=0.001; Morise score: 0.97, 0.93-1.02, P=0.20). The DTS was independent predictor of MI or revascularization, whereas FIT predicted death from any cause. Excluding patients with early revascularization, DTS had no predictive power at the composite endpoint.
Conclusion:
In our population with asymptomatic CAD, FIT and DTS had significant value for risk prediction and consequently the EET can be a valid tool in the clinical follow-up of this population.
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