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Determinants of a positive exercise test in patients admitted with acute non-infarct chest pain
R Moreno1, J L Cantalapiedra, E López de Sá
1Cardiology Department, Hospital Gregorio Marañón, Doctor Esquerdo, Madrid, Spain.
Background And Objectives:
Some patients with suspected unstable angina show ischemia at the exercise treadmill test despite having been medically stabilized. The objective of this study was to determine clinical characteristics predicting a positive exercise treadmill test in patients with suspected unstable angina after medical stabilization.
Methods:
In 885 hospitalized patients with medically stabilized unstable angina, the relationship between the result of the pre-discharge exercise treadmill test and clinical characteristics was studied.
Results:
Mean age was 62+/-9 years and 668 (75%) were male. Exercise test was positive (chest pain and/or ST depression > or =1 mm) in 288 patients (33%). Univariate analysis showed the following associated with ischemia at the exercise test: male gender (56% vs. 20%, P<0.001 ), diabetes mellitus (41% vs. 31%, P=0.009), previous unstable angina (41% vs. 24%, P=0.001), previous stable angina (44% vs. 30%, P<0.001), previous coronary artery bypass grafting (43% vs. 31%, P=0.043), peripheral artery disease (45% vs. 31%) and progressive angina (55% vs. 31%, P<0.001). Multivariate analysis showed the following as independent predictors of ischemia: male gender (OR=2.25), diabetes (OR=4.12), previous unstable angina (OR=3.89), previous stable angina (OR=3.74) and progressive angina (OR=4.05).
Conclusions:
In patients with suspected unstable angina, after medical stabilization: (1) the exercise treadmill test is positive in one-third of cases; (2) male gender, diabetes, previous angina (unstable and stable) and progressive angina are independent predictors of ischemia.