[Value of the stress test in patients with coronary spasm].
Ninety-one consecutive patients with angiographically documented spasm who performed a bicycle stress test within one week before diagnostic coronary angiography are studied. Stress test induced ST elevation in 8 patients (9%), ST depression in 37 (41%) and no ST shifts in 46 (50%). ST response to exercise did not correlate with any of the clinical variables assessed except for coronary anatomy. ST depression was a highly specific sign of underlying coronary lesions, with a high positive predictive value (89%). Patients were stratified according to the type of angina and their post-test probability of significant coronary disease was calculated following Bayes' theorem. The post-test likelihoods of significant coronary stenosis (positive and negative test, respectively) were: 82 and 37% for patients with angina at rest; 90 and 53% for those with effort angina, and 98 and 85% for those with mixed angina.


CONCLUSIONS
1) stress testing in patients with coronary spasm correlates well with coronary anatomy; 2) ST depression strongly suggests the presence of underlying coronary stenosis; 3) stress testing is especially useful in patients with angina exclusively at rest.
R
R
Castelló
E
E
Alegría
A
A
Merino
R
R
Hidalgo
M
M
Aparici
D
D
Martínez Caro
D000328:Adult; D000368:Aged; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000503:physiopathology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion
El valor de la prueba de esfuerzo en pacientes con espasmo coronario.