Slow heart rate recovery independently predicted adverse events after a negative exercise test, while event rates were similar between stress echocardiography and stress electrocardiography (10.3% vs 10.0%; p=0.888).
Cohort (n=862)
Does slow heart rate recovery predict long-term adverse events in patients with chest pain and an intermediate (15-65%) pre-test probability of CAD after a negative exercise test?
In patients with chest pain and an intermediate pre-test probability of CAD who have a negative exercise test, slow heart rate recovery, male gender, age, and diabetes identify a subset at increased risk for long-term adverse events.
Absolute Event Rate: 10.3% vs 10%
p-value: p=0.888
Background: The prognosis of patients with chest pain after a negative exercise test is good, but some adverse events occur in this low-risk group. The aim of our study was to identify predictors of long-term adverse events after a negative exercise test in patients with chest pain and a lower intermediate (15–65%) pre-test probability of coronary artery disease (CAD) and to assess the prognostic value of exercise electrocardiography and exercise stress echocardiography in this group of patients. Methods: We identified from our stress test laboratory database 862 patients with chest pain without previously known CAD and with a pre-test probability of CAD ranging from 15 to 65% (mean 41 ± 14%) who underwent exercise testing. Patients were followed for the occurrence of death, non-fatal myocardial infarction (MI) and clinically guided revascularization. Results: During the median follow-up of 94 months, 87 patients (10.1%) had an adverse event (AE). A total of 30 patients died (3.5%), 23 patients suffered non-fatal MI (2.7%) and 34 patients (3.9%) had clinically guided revascularization (20 patients percutaneous and 14 patients surgical revascularizations). Male gender, age, the presence of diabetes and a slow heart rate recovery (HRR) in the first minute after exercise were independently related to the occurrence of AEs. Adverse events occurred in 10.3% of patients who were tested by exercise stress echocardiography and in 10.0% of those who underwent stress electrocardiography (p = 0.888). Conclusion: The risk of AEs after negative exercise testing in patients with a pre-test probability of CAD of 15–65% is low. Male patients with a history of diabetes and slow HRR in the first minute after exercise have an increased risk of an adverse outcome.
Giga et al. (Fri,) conducted a cohort in Chest pain with 15-65% pre-test probability of CAD (n=862). Exercise stress echocardiography vs. Stress electrocardiography was evaluated on Adverse events (death, non-fatal myocardial infarction, and clinically guided revascularization) (p=0.888). Slow heart rate recovery independently predicted adverse events after a negative exercise test, while event rates were similar between stress echocardiography and stress electrocardiography (10.3% vs 10.0%; p=0.888).
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