The basal electrocardiogram and the exercise stress test in assessing prognosis in patients with unstable angina
S Severi1, E Orsini, P Marraccini
1C.N.R. Institute of Clinical Physiology, University of Pisa, Italy.
Insights
Basal electrocardiogram (ECG) and exercise stress tests can identify unstable angina patients with excellent long-term prognosis. These non-invasive tests help select patients who may avoid coronary angiography, reducing costs without compromising health.
Area of Science:
- Cardiology
- Diagnostic Medicine
- Prognostic Biomarkers
Background:
- Unstable angina requires accurate risk stratification for optimal patient management.
- Coronary angiography, while definitive, is invasive and costly.
- Non-invasive tests like ECG and exercise stress testing are crucial for initial patient assessment.
Purpose of the Study:
- To assess the prognostic value of basal electrocardiogram (ECG) and exercise stress tests in patients with unstable angina.
- To identify a subgroup of unstable angina patients with favorable long-term outcomes who might avoid invasive procedures.
Main Methods:
- A cohort of 374 unstable angina patients underwent ECG and exercise stress testing.
- Patients were categorized into four groups based on ECG and stress test results (normal/abnormal ECG, negative/positive stress test).
- Outcomes including need for coronary bypass surgery and eight-year survival rates were analyzed across groups.
Main Results:
- Coronary atherosclerosis severity and left ventricular dysfunction increased progressively from Group 1 (normal ECG, negative stress test) to Group 4 (abnormal ECG, positive stress test).
- Group 1 showed excellent outcomes: 100% eight-year survival and only one patient needing bypass surgery.
- Groups 2, 3, and 4 exhibited progressively worse outcomes, with significant differences in survival and intervention rates compared to Group 1.
Conclusions:
- Basal ECG and exercise stress testing effectively stratify risk in unstable angina patients.
- Patients with normal ECG and negative stress tests (Group 1) have an excellent long-term prognosis.
- These non-invasive tests can identify low-risk patients, potentially allowing them to forgo coronary angiography and reduce healthcare costs.
Abstract:
The purpose of this study was to evaluate the prognostic usefulness of basal electrocardiogram and exercise stress test in 374 patients with unstable angina submitted to coronary angiography during the same hospitalization period. After stabilization of symptoms by medical therapy, patients were subdivided into four groups according to the ECG and stress test: Group 1 (54 patients with normal ECG and exercise stress test negative for ischaemia); Group 2 (86 patients with normal ECG and exercise stress test positive for ischaemia); Group 3 (59 patients with abnormal ECG and exercise stress test negative for ischaemia); Group 4 (175 patients with abnormal ECG and exercise stress test positive for ischaemia). The severity of coronary atherosclerosis and impairment of left ventricular function increased progressively from Group 1 to 4, although differences in ventricular function were not significant between Groups 2 and 3. When discharged, patients were treated with verapamil and nitrates and followed for a period ranging from 1 to 8 years; during follow-up, only one patient of Group 1 underwent coronary bypass surgery, compared to 22, 7 and 46 patients in Groups 2, 3 and 4, respectively. The eight-year survival rate in the four groups (1-4) was 100%, 97%, 88% and 70%, respectively. Statistically significant differences were observed between Groups 1 and 3, 1 and 4, 2 and 4, and 3 and 4. Thus, the ECG and exercise stress test allow a population of patients with unstable angina to be selected (Group 1), having excellent long-term prognosis. These patients could avoid angiography, thereby reducing hospital costs, without compromising their health.
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