title: Ambulatory ST-recording has no additional value to exercise test for identification of severe coronary lesions after an episode of unstable coronary artery disease in men.
abstract: One month after an episode of unstable coronary artery disease, 95 male patients performed coronary angiography, 48 hours ambulatory ST-recording and also an exercise test. ST-depression occurred in 29.5% during the ST-recording and in 44.2% during the exercise test (p < 0.05). In patients with ST-depression at ambulatory monitoring, 79% demonstrated the same finding at the exercise test. A high risk response at the exercise test--defined as either ST-depression in > or = 3 leads, ST-depression in 1-2 leads with a maximal work load below the 60th percentile or a maximal work load below the 30th percentile regardless of the ECG reaction--occurred in 56.8%. Severe coronary lesions--defined as three vessel disease, left main stenosis or proximal left anterior descending artery stenosis as part of two vessel disease--was observed in 46.3%. Patients with a high risk exercise test response and patients with ST-depression during ST-recording had severe coronary lesions in 67% and 64% respectively. However, a high risk exercise test response occurred in 82%, while ST-depression at ambulatory monitoring was observed only in 41% of the patients with severe coronary lesions (p < 0.001). Thus, ambulatory ST-recording one month after an episode of unstable coronary artery disease in men adds no further information to a symptom limited exercise test in order to identify patients with severe coronary lesions.
authors.affiliation: Department of Cardiology, University Hospital, Linköping, Sweden.
authors.forename: J E
authors.initials: JE
authors.lastname: Karlsson
authors.forename: A
authors.initials: A
authors.lastname: Björkholm
authors.forename: P
authors.initials: P
authors.lastname: Blomstrand
authors.forename: J
authors.initials: J
authors.lastname: Ohlsson
authors.forename: L
authors.initials: L
authors.lastname: Wallentin
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000150:complications*; D003327:Coronary Disease / Q000175:diagnosis*; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies