Key result
An inconclusive exercise test or inability to exercise independently predicted death or acute coronary syndrome admission.
Why the study?
Does an inconclusive exercise test or inability to exercise predict death and ACS admission in patients with recent onset suspected cardiac chest pain?
Observational (n=1,851)
Does an inconclusive exercise test or inability to exercise predict death and ACS admission in patients with recent onset suspected cardiac chest pain?
Answers are grounded in this paper and cite their sources.
In patients with suspected cardiac chest pain, an inconclusive exercise test or inability to exercise is a strong independent predictor of adverse events, highlighting the need for early non-exercise cardiac imaging in this high-risk subgroup.
AIMS: To assess the prognostic value of an inconclusive exercise test or inability to exercise in patients with recent onset suspected cardiac chest pain and to determine the independent predictors of events in these patients. METHODS: This was an observational follow-up study of patients presenting to a rapid access chest pain clinic with a history of recent-onset suspected cardiac chest pain as referred by the family practitioner. The main outcome measure was a composite endpoint of death and acute coronary syndrome hospital admission. RESULTS: The study cohort consisted of 1851 patients in whom a total of 147 events were recorded during a mean follow-up period of 4.1 ± 1.1 years. Those with events were significantly older (65.1 ± 12.5 years versus 56.4 ± 13.2 years, p < 0.001), had higher mean pre-test probability of coronary artery disease (CAD), and had higher prevalence of diabetes (18.4% vs. 13.6%, p < 0.001), hypertension (55.8% vs. 38.7%, p < 0.001), and smoking (36.7% vs. 25.4%, p = 0.03) than those without events. These patients were also more likely to have a positive exercise electrocardiogram (ECG) (15.6% vs. 8.6%, p < 0.001) or not have a diagnostic exercise test because of an inconclusive result or inability to exercise (60.5% vs. 28.6%, p < 0.001). Cox multivariate regression analysis showed that age (hazard ratio, HR 1.03, p < 0.001), pre-test probability of CAD (HR 1.08, p = 0.04), positive exercise ECG (HR 2.94, p < 0.001), and an inconclusive test or inability to exercise (HR 3.45, p < 0.001) were independent predictors of events. CONCLUSIONS: In patients with recent onset suspected cardiac chest pain, not having a diagnostic exercise ECG because of an inconclusive test or inability to exercise is an independent predictor of events and has similar prognostic implications to a positive exercise ECG. In addition, pre-test probability estimation at baseline is a robust indicator of clinical outcome. Future models of care need to incorporate early and increased access to non-exercise cardiac imaging techniques in order to meet the needs of this high-risk subgroup of patients.
No takes yet. Share an insight, caveat, or question.
Khattar et al. (2011) conducted an observational in recent onset suspected cardiac chest pain (n=1,851). Inconclusive exercise test or inability to exercise vs. Diagnostic exercise test was evaluated on composite endpoint of death and acute coronary syndrome hospital admission (HR 3.45, p=<0.001). An inconclusive exercise test or inability to exercise independently predicted death or acute coronary syndrome admission.
Synapse has enriched 10 related papers. Consider them for comparative context: