Abstract 17547: Stress Induced Chest Pain is Associated With a Better Survival in Patients With Suspected Coronary Artery Disease
Background and hypothesis: We hypothesized that exercise stress induced chest pain may be protective in patients with suspected coronary artery disease (CAD) by limiting levels of stress and amount of ischemia and also attracting attention to the possibility of CAD resulting in appropriate disease modifying therapy. This was tested in a large cohort of patients undergoing exercise stress testing.
Methods: A total 9941 unique patients underwent exercise stress testing at our institution in the period 1993 to 2007 of whom 1494 (15%) had stress induced chest pain. Mortality data was obtained from National Death Index and survival was analyzed as a function of chest pain.
Results: The patient characteristics were as follows: age 60±13 years, 68% men, baseline heart rate 75±14 bpm, mean blood pressure 130/79 mmHg, LV ejection fraction 56±15%. The peak stress heart rate was 132±24 bpm, and MET level obtained 8.5±3.5. Over 8.2 years there were 1885 deaths. Presence of chest pain on exercise was associated with better survival (p<0.0001) on univariate analysis which remained significant (p=0.0009, HR 0.77) after adjusting for age (p<0.0001, HR 1.04 per year), gender (p<0.0001, HR for female 0.64), rest heart rate (p<0.0001, HR 1.008 per bpm), stress heart rate (p<0.0001, HR 0.988 per bpm), peak stress systolic blood pressure (0.001, HR 1.002 per mmHg), MET level attained (p<0.0001, 0.95 per MET), ST segment depression (p=0.51, HR 1.04) and performance of coronary angiography (p<0.0001, HR 1.37).
Conclusions: 1) Stress induced chest pain is independently associated with a better survival in patients with known or suspected CAD. 2) We speculate that presence of anginal pain may limit the extent and frequency of myocardial ischemia or trigger therapeutic measures with a consequent reduction in cardiac events.
- © 2010 by American Heart Association, Inc.