Key result
The stress-recovery index independently predicted adverse outcomes in hypertensive patients with chest pain (HR 0.69 per interquartile difference), adding significant prognostic value to standard clinical and exercise testing.
Why the study?
Does the stress-recovery index (SRI) improve prediction of all-cause mortality in hypertensive patients with chest pain compared to standard exercise testing?
Cohort (n=460)
Yes
Does the stress-recovery index (SRI) improve prediction of all-cause mortality in hypertensive patients with chest pain compared to standard exercise testing?
The stress-recovery index during exercise electrocardiography provides significant incremental prognostic value for predicting all-cause mortality in hypertensive patients with chest pain.
BACKGROUND: Exercise electrocardiography has limited prognostic accuracy in hypertensives because of unsatisfactory specificity. We prospectively used comparative stress-recovery heart rate-adjusted ST (ST/HR) analysis to predict mortality in a consecutive population of hypertensives with chest pain. METHODS: The stress-recovery index (SRI), defined as the difference between ST/HR areas during exercise and recovery, was derived in 460 hypertensive with known (n=360, 78%) or suspected (n=100, 22%) coronary artery disease. To assess whether it added prognostic information to routinely obtained information, clinical data, the resting ejection fraction, and exercise testing data were entered into a sequential Cox's model; the SRI was entered last. Model validation was performed by bootstrap adjusted by the degree of optimism in estimates. Survival analysis was performed using the product-limit Kaplan-Meier method. RESULTS: During a median follow-up of 28 months (interquartile range, 13-44 months), 32 (7%) patients died, 23 (5%) suffered from acute myocardial infarction and 60 (13%) underwent late (> 3 months) revascularization. Male gender (hazard ratio, 1.53; 95% confidence interval, 1.01-2.34), peak double product (hazard ratio, 0.70; 95% confidence interval, 0.54-0.90) and the SRI (hazard ratio, 0.69; 95% confidence interval, 0.59-0.81 for interquartile difference) were independent predictors of outcome. The SRI increased the prognostic power of the model on top of clinical and exercise testing variables (concordance index, + 10%; discrimination index, + 32%) and showed the widest area under the ROC curve to predict outcome as compared with exercise-only ST analysis and the ST/HR index. Moreover, it provided a significant discrimination of survival. CONCLUSIONS: The SRI predicts all-cause mortality in hypertensive patients with chest pain and provides additional prognostic information over clinical and standard exercise testing data.
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Bigi et al. (2004) conducted a cohort in Hypertension with chest pain (n=460). Stress-recovery index (SRI) vs. Lower SRI values was evaluated on Composite of all-cause death, non-fatal myocardial infarction, and late myocardial revascularization (HR 0.69, 95% CI 0.59-0.81). The stress-recovery index independently predicted adverse outcomes in hypertensive patients with chest pain (HR 0.69 per interquartile difference), adding significant prognostic value to standard clinical and exercise testing.
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