DETERMINANTS OF A POSITIVE EXERCISE TEST IN PATIENTS ADMITTED WITH ACUTE NONINFARCT CHEST PAIN

Background and objectives. Some patients with suspected unstable angin a show ischemia at the exercise treadmill test despite having been med ically stabilized. The objective of this study was to determine clinic al characteristics predicting a positive exercise treadmill test in pa tients with suspected unstable angina after medical stabilization. Met hods. In 885 hospitalized patients with medically stabilized unstable angina, the relationship between the result of the pre-discharge exerc ise treadmill test and clinical characteristics was studied. Results. Mean age was 62+/-9 years and 668 (75%) were male. Exercise test was p ositive (chest pain and/or ST depression greater than or equal to 1 mm ) in 288 patients (33%). Univariate analysis showed the following asso ciated with ischemia at the exercise test: male gender (56% vs. 20%, P <0.001), diabetes mellitus (41% vs. 31%, P=0.009), previous unstable a ngina (41% vs. 24%, P=0.001), previous stable angina (44% vs. 30%, P<0 .001), previous coronary artery bypass grafting (43% vs. 31%, P=0.043) , peripheral artery disease (45% vs. 31%) and progressive angina (55% vs. 31%, P<0.001). Multivariate analysis showed the following as indep endent predictors of ischemia: male gender (OR=2.25), diabetes (OR=4.1 2), previous unstable angina (OR=3.89), previous stable angina (OR=3.7 4) and progressive angina (OR=4.05). Conclusions. In patients with sus pected unstable angina, after medical stabilization: (1) the exercise treadmill test is positive in one-third of cases; (2) male gender, dia betes, previous angina (unstable and stable) and progressive angina ar e independent predictors of ischemia. (C) 1998 Elsevier Science Irelan d Ltd. All rights reserved.