Prognostic value of stress testing in patients over 75 years of age with chronic angina.
OBJECTIVE
To define the prognostic value of stress testing (STRT) in patients >or= 75 years of age.


METHODS
Multicenter prospective randomized trial.


METHODS
Tertiary care centers.


METHODS
Two hundred ninety-two patients of the Trial of Invasive vs Medical Treatment of Elderly Patients aged >or= 75 years with chronic angina despite receiving two or more antianginal drugs were prospectively observed for 1 year.


METHODS
STRT (88% exercise ECG; 12% pharmacologic stress imaging) was performed if possible, and ischemia was diagnosed using current guidelines. Death for any reason and nonfatal myocardial infarction were outcome events.


RESULTS
Patients who could perform STRT (148 patients) were younger, had a lower risk profile, received less medication, and had less severe angina than patients who could not perform STRT (144 patients). The 1-year mortality rate was only 1.4% in patients with negative STRT results (72 patients) compared to 5.3% in patients with positive STRT results (76 patients) and 13.7% in patients who had not undergone STRT due to unstable symptoms (95 patients). The corresponding 1-year rates of death/infarction were 2.8%, 15.8%, and 26.3%, respectively. After adjustment for baseline differences, mortality rates were no longer significantly different. However, compared to patients with negative STRT results, infarction and death/infarction rates remained higher in patients with provocable ischemia (hazard ratio [HR], 8.9 [p = 0.04]; HR, 6.1 [p = 0.02], respectively) and in patients without STRT due to unstable angina (HR, 11.8 [p = 0.02]; HR, 8.6 [p =.004], respectively).


CONCLUSIONS
STRT in elderly patients is feasible and provides important prognostic information for their future management. Patients with negative STRT results after receiving therapy have a good prognosis, and their conditions may be managed conservatively.
Division of Cardiology, University Hospital Basel, Switzerland.
Raban V
RV
Jeger
Michael J
MJ
Zellweger
Christoph
C
Kaiser
Leticia
L
Grize
Stefan
S
Osswald
Peter T
PT
Buser
Matthias E
ME
Pfisterer
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000150:complications / Q000175:diagnosis*; D002908:Chronic Disease; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity