Typical angina during exercise stress testing improves the prediction of future acute coronary syndrome
Lindow, Thomas LU ; Ekström, Magnus LU
; Brudin, Lars
; Carlén, Anna
; Elmberg, Viktor
LU
and Hedman, Kristofer
(2021)
In Clinical Physiology and Functional Imaging
41(3).
p.281-291
- Abstract
Introduction: The prognostic value of angina during exercise stress testing is controversial, possibly due to previous studies not differentiating typical from non-typical angina. We aimed to assess the prognostic value of typical angina alone, or in combination with ST depression, during exercise stress testing for predicting cardiovascular events. Methods: We conducted a prospective observational cohort study including all patients who performed a clinical exercise stress test at the department of Clinical Physiology, Kalmar County Hospital between 2005 and 2012. The association between typical angina/ST depression and incident acute coronary syndrome (ACS) and cardiovascular mortality were analysed using Cox regression for long-term... (More)
Introduction: The prognostic value of angina during exercise stress testing is controversial, possibly due to previous studies not differentiating typical from non-typical angina. We aimed to assess the prognostic value of typical angina alone, or in combination with ST depression, during exercise stress testing for predicting cardiovascular events. Methods: We conducted a prospective observational cohort study including all patients who performed a clinical exercise stress test at the department of Clinical Physiology, Kalmar County Hospital between 2005 and 2012. The association between typical angina/ST depression and incident acute coronary syndrome (ACS) and cardiovascular mortality were analysed using Cox regression for long-term and 1-year follow-up. Results: Out of 11605 patients (median follow-up 6.7 years), 623 (5.4%) developed ACS and 319 (2.7%) died from cardiovascular causes. Compared to patients with no angina and no ST depression, typical angina and ST depression were associated with increased risk of future ACS; hazard ratio (HR) 3.5 ([95%CI] 2.6–4.7). This association was even stronger for ACS within one year (typical angina with and without concomitant ST depression; HR 20.8 (13.9–31.3) and 9.7 (6.1–15.4), respectively). Concordance statistics for ST depression in predicting ACS during long-term follow-up was 0.58 (0.56–0.60) and 0.69 (0.65–0.73) for ACS within one year, and 0.64 (0.62–0.66) and 0.77 (0.73–0.81), respectively, when typical angina was added to the model. Conclusions: Typical angina during exercise stress testing is predictive of future ACS, especially in combination with ST depression, and during the first year after the test.
(Less)
- author
- Lindow, Thomas
LU
; Ekström, Magnus
LU
; Brudin, Lars
; Carlén, Anna
; Elmberg, Viktor
LU
and Hedman, Kristofer
- organization
- publishing date
- 2021-05-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acute myocardial infarction, exercise ECG, risk stratification, unstable angina
- in
- Clinical Physiology and Functional Imaging
- volume
- 41
- issue
- 3
- pages
- 11 pages
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85101497919
- pmid:33583090
- ISSN
- 1475-0961
- DOI
- 10.1111/cpf.12695
- language
- English
- LU publication?
- yes
- id
- e8a6e7a6-3bee-400a-9ed7-ad7797f990aa
- date added to LUP
- 2022-03-04 09:33:19
- date last changed
- 2024-06-16 10:10:44
@article{e8a6e7a6-3bee-400a-9ed7-ad7797f990aa,
abstract = {{<p>Introduction: The prognostic value of angina during exercise stress testing is controversial, possibly due to previous studies not differentiating typical from non-typical angina. We aimed to assess the prognostic value of typical angina alone, or in combination with ST depression, during exercise stress testing for predicting cardiovascular events. Methods: We conducted a prospective observational cohort study including all patients who performed a clinical exercise stress test at the department of Clinical Physiology, Kalmar County Hospital between 2005 and 2012. The association between typical angina/ST depression and incident acute coronary syndrome (ACS) and cardiovascular mortality were analysed using Cox regression for long-term and 1-year follow-up. Results: Out of 11605 patients (median follow-up 6.7 years), 623 (5.4%) developed ACS and 319 (2.7%) died from cardiovascular causes. Compared to patients with no angina and no ST depression, typical angina and ST depression were associated with increased risk of future ACS; hazard ratio (HR) 3.5 ([95%CI] 2.6–4.7). This association was even stronger for ACS within one year (typical angina with and without concomitant ST depression; HR 20.8 (13.9–31.3) and 9.7 (6.1–15.4), respectively). Concordance statistics for ST depression in predicting ACS during long-term follow-up was 0.58 (0.56–0.60) and 0.69 (0.65–0.73) for ACS within one year, and 0.64 (0.62–0.66) and 0.77 (0.73–0.81), respectively, when typical angina was added to the model. Conclusions: Typical angina during exercise stress testing is predictive of future ACS, especially in combination with ST depression, and during the first year after the test.</p>}},
author = {{Lindow, Thomas and Ekström, Magnus and Brudin, Lars and Carlén, Anna and Elmberg, Viktor and Hedman, Kristofer}},
issn = {{1475-0961}},
keywords = {{acute myocardial infarction; exercise ECG; risk stratification; unstable angina}},
language = {{eng}},
month = {{05}},
number = {{3}},
pages = {{281--291}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Clinical Physiology and Functional Imaging}},
title = {{Typical angina during exercise stress testing improves the prediction of future acute coronary syndrome}},
url = {{http://dx.doi.org/10.1111/cpf.12695}},
doi = {{10.1111/cpf.12695}},
volume = {{41}},
year = {{2021}},
}