Abstract 12580: Inability to Exercise or an Inconclusive Exercise Test Are Prognostically Equivalent to a Positive Exercise Test in Patients With Recent Onset Suspected Cardiac Chest Pain.
Introduction: Treadmill exercise electrocardiography (ExECG) remains a commonly used first line investigation for the diagnostic evaluation of suspected cardiac chest pain. However, approximately 25–30%; of patients are unable to exercise or have an inconclusive test and the prognosis of these patients is unclear.
Hypothesis: We aimed to determine the independent predictors of outcome in patients with suspected cardiac chest pain undergoing ExECG and tested the hypothesis that those who are unable to exercise or have an inconclusive ExECG have an adverse clinical outcome.
Methods: We studied consecutive patients who attended our rapid access chest pain service from January 2004 to December 2006.The parameters analyzed included age, gender, diabetes, hypertension, hypercholesterolemia, smoking, previous CAD, chest pain symptoms and ExECG diagnosis. Follow-up data on all-cause death and acute coronary syndromes were collected.
Results: The study cohort consisted of 1,851 patients with a total of 147 events recorded during a mean follow-up period of 4.1 ± 1.1 years. Those with events were significantly older (56 ±13 vs 65±13 years; p<0.001) and had higher prevalences of diabetes (14%; vs 18%;; p<0.001), hypertension (39%; vs 56%;; p<0.001)), and smoking (25%; vs 37%;; p<0.001). These patients were also more likely to have a positive ExECG (16%; vs 9%;, p<0.001) or no diagnostic ExECG due to inability to exercise or an inconclusive test (61%; vs 29%;, p<0.001). Multivariate analysis showed that age (HR 1.04, p<0.001), previous CAD (HR 2.0, p=0.04), positive ExECG (HR 3.6, p<0.001) and no diagnostic ExECG (HR 3.8, p<0.001) were independent predictors of events. Kaplan Meier curves are shown in Figure 1.
Conclusions: In patients with suspected cardiac chest pain, an inconclusive test or inability to exercise is an independent predictor of events and has similar prognostic implications to a positive ExECG. These patients need early access to appropriate cardiac imaging modalities.
- © 2010 by American Heart Association, Inc.