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Prognosis of medically treated patients with coronary-artery disease with profound ST-segment depression during
Insights
Profound ST-segment depression during exercise stress tests in coronary heart disease patients does not predict a poor prognosis. Medical management is effective, with low mortality, and cardiac surgery is rarely needed.
Area of Science:
- Cardiology
- Exercise Physiology
- Clinical Medicine
Background:
- Profound ST-segment depression during exercise testing in coronary heart disease (CHD) patients is often linked to multivessel coronary artery disease.
- Coronary-artery bypass surgery is frequently recommended for these patients, even without symptoms, due to concerns about prognosis.
- Limited long-term data exist on the outcomes of medical management for patients with this exercise test finding.
Purpose of the Study:
- To evaluate the long-term prognosis of patients with coronary heart disease who exhibit reproducible profound ST-segment depression during exercise testing when treated medically.
- To determine if the degree of ST-segment depression or other exercise parameters correlate with patient survival.
Main Methods:
- A cohort of 212 men with coronary artery disease underwent exercise testing, identifying 142 with reproducible profound ST-segment depression (mean 2.9 mm) and no other cardiac conditions or digitalis use.
- These patients were followed for an average of 59 months.
- Survival rates were analyzed in relation to exercise tolerance, degree of ST depression, peak heart rate, and peak blood pressure.
Main Results:
- The annual mortality rate was 1.4% (11 deaths over 59 months).
- 9 patients (1.3% per year) underwent bypass surgery during the follow-up period.
- Survival was significantly correlated with exercise tolerance, but not with the degree of ST-segment depression, peak heart rate, or peak blood pressure.
Conclusions:
- Reproducible profound ST-segment depression on exercise testing in medically managed CHD patients is not associated with a poor long-term prognosis.
- Medical management appears highly successful, demonstrating a low mortality rate.
- Cardiac surgery is infrequently required, suggesting conservative management is often appropriate for this patient group.
Abstract:
Reproducible and profound (greater than 2 mm) ST-segment depression during exercise testing in patients with coronary heart disease is associated with multivessel involvement. In these patients, coronary-artery bypass surgery has been recommended even when symptoms are absent. However, there are few long-term follow-up data regarding the prognosis when such patients are treated medically. Among 212 men with coronary-artery disease in whom profound ST-segment depression could be reproduced with exercise, 142 who had no other type of heart disease and were not receiving digitalis drugs had a mean ST-segment depression of 2.9 mm. Follow-up has lasted an average of 59 months: 11 patients have died (annual mortality, 1.4 per cent), and nine have had bypass operations (1.3 per cent per year). Survival correlated with exercise tolerance but not with degree of ST depression, peak heart rate, or peak blood pressure during exercise. We conclude that such ST-segment depression is not associated with a poor prognosis. There is rarely a need to resort to cardiac surgery; medical management is highly successful and associated with a low mortality.