Prognostic value of risk factors and exercise testing in men with atypical chest pain.
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.
D000206:Actuarial Analysis; D000328:Adult; D000367:Age Factors; D000787:Angina Pectoris / Q000503:physiopathology*; D003327:Coronary Disease / Q000503:physiopathology; D004562:Electrocardiography; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000503:physiopathology; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D011379:Prognosis; D012306:Risk; D012907:Smoking; D013909:Thorax