History, exercise test, and prognosis of chest pain

Three hundred and eighteen patients were followed up for periods up to seven years (mean, 37.5 months) after an initial assessment of their history followed by a symptom-limited exercise test. Twenty-four of the subjects (7.6%) died, eight within one month of being seen within the unit. The major determinant of mortality was the presence and severity of effort angina. Thus, the survival rates of patients with severe angina, mild angina, and atypical pain were 86.8%, 97.6%, and 99.5% at one month and 73%, 82%, and 93% at five years respectively. The occurrence of angina or ST-segment depression, reduced working capacity, and peak heart rate on exercise testing were all associated with an increased risk of premature mortality. However, the exercise testing abnormalities were closely correlated with the presence and severity of angina by history, except in patients with atypical histories. The major contribution of exercise tests is to the patients with atypical, but possibly eschaemic, chest pains.