Coronary Artery DiseaseRisk stratification of patients with medically treated unstable angina using exercise echocardiography
Section snippets
Patient selection
We prospectively gathered data on 226 consecutive patients with unstable angina who underwent exercise echocardiography between 1991 and 1996 at the Cleveland Clinic Foundation. Unstable angina was defined according to previously established guidelines by the U.S. Department of Health and Human Services: (1) rest angina within 1 week of presentation; (2) new-onset angina of Canadian Cardiovascular Classification class III or IV within 2 months of presentation; and (3) variant angina.9 Higher
Clinical characteristics
Two hundred twenty-six patients (mean age 59 ± 13 years, 128 men) underwent exercise echocardiography for evaluation of unstable angina. One hundred eighty-two patients (80%) were considered to have high or intermediate likelihood of CAD. Although 109 patients (48%) had previous CAD, mean ejection fraction was only mildly reduced to 49 ± 11%. Diabetes mellitus was present in 115 patients (51%), systemic hypertension in 51 patients (23%), cigarette smoking in 113 patients (50%), and
Discussion
In this study, exercise testing was safe for the evaluation of low- to intermediate-risk patients with medically treated unstable angina. Results indicate that exercise echocardiography, but not exercise ECG, is predictive of subsequent events in medically treated patients with unstable angina. These results are independent of the clinical risk profile, although patients at the highest risk (diabetics and patients with known coronary disease) were not additionally risk-stratified by exercise
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