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Prognostic value of risk factors and exercise testing in men with atypical chest pain

1983; Elsevier BV; Volume: 3; Issue: 1 Linguagem: Inglês

10.1016/0167-5273(83)90059-1

1874-1754

Kenneth F. Hossack, Robert A. Bruce, Lloyd D. Fisher, Verona Hofer,

Acute Myocardial Infarction Research

Of 551 men with atypical chest pain enrolled in the Seattle Heart Watch Study, annual follow-up over a 5- to 10-year period identified 36 persons who experienced a primary coronary heart disease event. Only three events were fatal, and they were in men over the age of 50. Cox's regression model confirmed a significant association of the conventional risk factors of smoking (P = 0.03), elevated resting systolic blood pressure (P = 0.02) and hypercholesterolemia (P = 0.03) with primary coronary heart disease events. A count of these three variables was highly predictive (P = 0.002). A positive family history was not predictive. Functional aerobic impairment (P = 0.002) and ST depression (P = 0.0003) were the most useful exercise predictors. In men who had neither risk factors nor abnormal exercise predictors, the percentage free of coronary events at 9 years was 96% compared to 76% in men with one or more of the abnormal exercise findings (P less than 0.0001). Of men with only risk factors, 86% remained free of events at 9 years. This study demonstrates that the evaluation of both risk factors and exercise responses enhances the prognostic evaluation of men with atypical chest pain. The classification of men into low-, medium- and high-risk groups can be easily accomplished in office practice.