Early symptom-limited exercise test for risk stratification in post menopausal women with unstable coronary artery disease

Aims The exercise test is considered less reliable in women than in men bot h for diagnostic and prognostic purposes. The value, however, of the exerci se test might vary with the population that is examined, the way the test i s performed and which exercise test variables are taken into consideration in the analysis. The aim of the study was to evaluate an early symptom-limi ted exercise test as a tool for risk stratification in women with unstable coronary artery disease admitted to the coronary care unit. Methods and Results Of the 543 women in the FRISC I study, 395 stabilized o n medical treatment and performed a symptom-limited exercise test 5-8 days after inclusion. Sixteen patients with a cardiac event before the scheduled exercise test were excluded. During the 6 months follow-up 17% of the wome n who did not perform the exercise test and 9% of the 395 women who did, di ed or had a myocardial infarction (P<0.01). Multivariate stepwise logistic regression analysis was performed to assess the value of clinical variables and findings at the predischarge exercise test to predict cardiac events. Based on the exercise test results three risk groups were identified with a n event rate of 19%, 9% and 1%, respectively. The exercise test was better than any of the tested clinical variables in predicting cardiac events. Conclusion Women with unstable coronary artery disease who do not stabilize within a few days have a high event rate early during follow-up. For women who are medically stabilized, considering not only variables like ST depre ssion and chest pain but also parameters reflecting the cardiac performance such as maximal workload and increase in rate-pressure product, an early s ymptom-limited exercise test is a good predictor of future cardiac events. (C) 2000 The European Society of Cardiology.