Risk stratification by early exercise testing after an episode of unstable coronary artery disease

Long-term prognosis of clinical variables, coronary reserve and extent of coronary disease in patients with a first episode of unstable angina

“…The IT, which is an indirect measure of coronary reserve, was also a remarkable long-term predictor for all complications and particularly for death and MI in patients with an IT V 130 beats/min. The fact that nearly two-thirds of all complicated patients had an IT V 150 beats/min is concordant with the short-term prognostic value of a predischarge positive stress test in patients with UA [2,27,28,29].…”

“…On the other hand, the absence of previous episodes of UA and of revascularization procedures together with the low incidence of previous infarction (12%) renders the prognostic value of our series more representative of the condition of UA in itself rather than of preceding events. Furthermore, even though the incidence of MI and cardiac death in patients with UA has been currently reduced by earlier use of revascularization procedures and more effective antiaggregant strategies, a similar prognostic value for most of our significant clinical variables has been shown in recent short-or midterm follow-up studies [2,11,22,28]. Therefore, it is likely that the prognostic value of the clinical variables herein analyzed and their mechanistic relationship with multivessel and a reduced coronary reserve is likely to prevail.…”

Safety and Utility of Exercise Testing in Emergency Room Chest Pain Centers

“…This is consistent with similar safety data reported in patient groups with a higher disease prevalence, such as patients presenting with unstable angina. [17][18][19][20][21][22][23][24][25][26][27][28][29] Utility, expressed as the incremental clinical value of exercise ECG testing when added to a chest pain center clinical algorithm, serial serum markers of myocardial necrosis, and serial ECG testing, has been demonstrated in at least 2 well-designed studies. 4,9 Key Points and Recommendations…”

“…[17][18][19][20][21][22][23][24][25][26][27][28] Swahn et al 23 reported on 400 patients Ͻ65 years of age who underwent symptom-limited predischarge exercise testing after stabilization of unstable angina using an electrically braked bicycle ergometer starting at 10 W with continuous load increases of 10 W/min. The incidence of exercise-induced ST-segment depression Ն1 mm was 33% in 272 men and 116 women.…”

Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease

“…The exercise tests were evaluated according to a model, used in a previous study [25], demonstrating that the number of leads with ST-depression or a low maximal work load were independent predictors of future cardiac events. Using a similar model of evaluation, a "high risk exercise test response" was defined as either ST-depression in >_ 3 leads, ST-depression in Thallium-201 SPECT acquisition and analysis ( Thallium-201 SPECT was performed post-exercise and at rest in 170 patients comprising the material in this report.…”