Skip to main content
SpringerLink
Log in

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

  • Articles
  • Published:
The International Journal of Cardiac Imaging Aims and scope Submit manuscript

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 ≥ 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%. Patents 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Feldman RL. Coronary thrombosis, coronary spasm and coronary atherosclerosis and speculation on the link between unstable angina and acute myocardial infarction (Editorial). Am J Cardiol 1987; 59: 1187–90.

    Google Scholar 

  2. Cowley MJ, DiSciasscio G, Rehr RB, Vetrovec GW. Angio-graphic Observations and Clinical Relevance of Coronary Thrombus in Unstable Angina Pectoris. Am J Cardiol 1989; 63: 108E-113E.

    Google Scholar 

  3. Williams AE, Freeman MR, Chisholm RJ, Patt NL, Armstrong PW. Angiographic Morphology in Unstable Angina Pectoris. Am J Cardiol 1988; 62: 1024–7.

    Google Scholar 

  4. Ambrose JA, Winters SL, Stern A, et al. Angiographic morphology and the pathogenesis in unstable angina. J Am Coll Cardiol 1985; 5: 609.

    Google Scholar 

  5. Sclarovsky S, Rechavia E, Strasberg B, et al. Unstable angina: ST segment depression with positive versus negative T wave deflections —Clinical course, ECG evolution, and angiographic correlation. Am Heart J 1988; 116: 933–41.

    Google Scholar 

  6. Papapietro SE, Niess OS, Paine TD, et al. Transient electro-cardiographic changes in patients with unstable angina: relation to coronary arterial anatomy. Am J Cardiol 1980; 46: 28–32.

    Google Scholar 

  7. European Coronary Surgery Study Group (director E Varnauskas). Long-term results of prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Lancet 1982; 2: 1173–80.

    Google Scholar 

  8. Varnauskas E, the European coronary surgery study group. Twelve-year follow-up in the randomized European coronary surgery study. N Engl J Med 1988; 319: 332–7.

    Google Scholar 

  9. Luchi RJ, Scott SM, Deupree RH, and the principal investigators and their associates of veterans administration cooperative study no. 28. Comparison of medical and surgical treatment for unstable angina pectoris. N Engl J Med 1987; 316: 977–84.

    Google Scholar 

  10. Parisi AF, Khuri S, Deupree RH, Sharma GVRK, Scott SM, Luchi RJ. Medical compared with surgical management of unstable angina. 5-year mortality and morbidity in the Vetarans Administration study. Circulation 1989; 80: 1176–89.

    Google Scholar 

  11. Task force on assessment of diagnostic and therapeutic cardiovascular procedures (chairman Fisch C). Guidelines and indications for coronary artery bypass graft surgery. A report of the American College of Cardiology/American Heart Association. J Am Coll Cardiol 1991; 17: 543–89.

    Google Scholar 

  12. Gottlieb SO, Weisfeldt ML, Quyang P, Mellits ED, Gerstenblith G. Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina. N Engl J Med 1986; 314: 1214–9.

    Google Scholar 

  13. Langer A, Freeman MR, Armstrong PW. ST segment shift in unstable angina: Pathophysiology and association with coronary anatomy and hospital outcome. J Am Coll Cardiol 1989; 13: 1495–502.

    Google Scholar 

  14. Dellborg M, Gustafsson G, Riha M, Swedberg K. Dynamic changes of the QRS-complex in unstable angina pectoris. Int J Cardiol 1992; 36: 151–62.

    Google Scholar 

  15. Butman SM, Olson HG, Gardin J, et al. Submaximal exercise testing after stabilization of unstable angina pectoris. J Am Coll Cardiol 1984; 4: 667–73.

    Google Scholar 

  16. Swahn E, Areskog M, Wallentin L. Early exercise testing after coronary care for suspected unstable coronary artery disease —safety and diagnostic value. Eur Heart J 1986; 7: 594–601.

    Google Scholar 

  17. Gibson RS, Beller GA, Gheroghiade M, et al. The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q-wave infarction: a prospective natural history study. Circulation 1986; 73: 1186–98.

    Google Scholar 

  18. Swahn E, Areskog M, Berglund U, Walfridsson H, Wallentin L. Predictive importance of clinical findings and a predischarge exercise test in suspected unstable coronary artery disease. Am J Cardiol 1987; 59: 208–14.

    Google Scholar 

  19. Sia STB, Macdonald PS, Horowitz JD, Goble AJ, Doyle AE. Usefulness of early exercise test after non-Q-wave myocardial infarction in predicting prognosis. Am J Cardiol 1986; 57: 738–44.

    Google Scholar 

  20. Wilcox I, Freedman SB, Allman KC, et al. Prognostic significance of a predischarge exercise test in risk stratification after unstable angina pectoris. J Am Coll Cardiol 1991; 18: 677–83.

    Google Scholar 

  21. Nyman I, Wallentin L, Areskog M, Areskog N-H, Swahn E, and the RISC study group. Risk stratification by early exercise testing after an episode of unstable coronary artery disease. Int J Cardiol 1993; 39: 131–42.

    Google Scholar 

  22. Johnson SM, Mauritson DR, Winniford MD, et al. Continuous electrocardiographic monitoring in patients with unstable angina pectoris: identification of high risk subgroup with severe coronary disease, variant angina, and/or impaired early prognosis. Am Heart J 1982; 103: 4–12.

    Google Scholar 

  23. Larsson H, Jonasson T, Ringqvist I, Fellenius C, Wallentin L. The diagnostic and prognostic importance of ST-recording compared to a predischarge exercise test after an episode of unstable angina or non-Q-wave myocardial infarction. Eur Heart J (in press).

  24. Larsson H, Areskog M, Areskog N-H, et al. Should the exercise test be performed at discharge or one month later after an episode of unstable angina or non-Q-wave myocardial infarction. Int J of Cardiac Imaging 1991; 7(1): 7–14.

    Google Scholar 

  25. Butman SM, Olson HG, Butman ME. Early exercise testing after stabilization of unstable angina: Correlation with coronary angiographic findings and subsequent cardiac events. Am Heart J 1986; 111: 11–8.

    Google Scholar 

  26. Griffith LSC, Varnauskas E, Wallin J, Bjurö T, Ejdebäck J. Correlation of coronary arteriography after acute myocardial infarction with predischarge limited exercise test response. Am J Cardiol 1988; 61: 201–7.

    Google Scholar 

  27. Karlsson J-E, Berglund U, Björkholm A, Ohlsson J, Swahn E, Wallentin L for the TRIC-study Group. Thrombolysis with recombinant human tissue-type plasminogen activator during instability in coronary artery disease: Effect on myocardial ischemia and need for coronary revascularization. Am Heart J 1992; 124: 1419–26.

    Google Scholar 

  28. Gillum RF, Fortman SP, Prineas RJ, Kottke TE. International diagnostic criteria for acute myocardial infarction and stroke. Progress in Cardiology 1984; 108: 150–7.

    Google Scholar 

  29. Borg G. Phycho-physical basis of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–81.

    Google Scholar 

  30. Borg G, Ottosson D, eds. The perception of exertion in physical work. Wennergren Center International Symposium Series, vol 46. London: MacMillan Press, Ltd, 1986.

    Google Scholar 

  31. Stern S, Tzivoni D. Diagnostic accuracy of ambulatory ECG monitoring in ischemic heart disease. Circulation 1975; 52: 1045–9.

    Google Scholar 

  32. Deanfield JE, Shea M, Ribierao P et al. Transient ST-de-pression as a marker of myocardial ischemia during daily life. Am J Cardiol 1984; 54: 1195–1200.

    Google Scholar 

  33. Pipberg HV, Arzbaecher RC, Berson AS, et al. Recommendation for standardization of leads and of specifications for instruments in electrocardiography and vectorcardiography. Circulation 1975; 52: 11–31.

    Google Scholar 

  34. Larsson H, Jonasson T, Ringqvist I, Fellenius C, Wallentin L. Diagnostic and prognostic importance of ST-recording after an episode of unstable angina or non-Q-wave myocardial infarction. Eur Heart J 1992; 13: 207–12.

    Google Scholar 

  35. Deanfield JE, Ribierao P, Oakley K, Krikler S, Selwyn AP. Analysis of ST-segment changes in normal subjects: implications for ambulatory monitoring in angina pectoris. Am J Cardiol 1984; 54: 1321–5.

    Google Scholar 

  36. Quyumi AA, Wright C, Fox K. Ambulatory electrocardiographic ST-segment changes in healthy volunteers. Br Heart J 1983; 50: 460–4.

    Google Scholar 

  37. Karlsson J-E, Björkholm A, Nylander E, Ohlsson J, Wallentin L. ST-changes in ECG at rest or during exercise indicate a high risk of severe coronary lesions after an episode of unstable coronary artery disease. Int J Cardiol (in press).

  38. Gottlieb SO, Gottlieb SH, Achuff SC, et al. Silent ischemia on Holler monitoring predicts mortality in high-risk postin-farction patients. JAMA 1988; 259: 1030–5.

    Google Scholar 

  39. Romeo F, Rosano GMC, Martuscelli E, Valente A, Reale A. Unstable angina: Role of silent ischemia and total ischemic time (silent plus painful ischemia), a 6-year follow-up. J Am Coll Cardiol 1992; 19: 1173–9.

    Google Scholar 

  40. Günther H, Osterspey A, Treis-Müller I, Eggeling T, Hopp HW, Hilger HH. The sensitivity of 24 h Holler monitoring and exercise testing for the recognition of myocardial ischemia: a comparative sludy. Eur Heart J 1988; 9 (Suppl N): 46–9.

    Google Scholar 

  41. Mulcahy D, Keegan J, Sparrow J, Park A, Wright C, Fox K. Ischemia in the ambulatory setting — the total ischemic burden: Relation to exercise testing and investigative and therapeutic implications. J Am Coll Cardiol 1989; 14: 1166–72.

    Google Scholar 

  42. Tzivini D, Gavish A, Zin D, et al. Prognostic significance of ischemic episodes in patients with previous myocardial infarction. Am J Cardiol 1988; 62: 661–4.

    Google Scholar 

  43. Nyman I, Larsson H, Areskog M, Areskog NH, Wallentin L. The predictive value of silent ischemia at an exercise test before discharge after an episode of unstable coronary artery disease. Am Heart J 1992; 123: 324–31.

    Google Scholar 

  44. Nademanee K, Intarachot V, Josephson MA, Rieders D, Mody FV, Singh BN. Prognostic significance of silent myocardial ischemia in patients with unstable angina. J Am Coll Cardiol 1987; 10: 1–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Cardiology, Clinical Physiology and Thoracic Radiology, University Hospital, Linköping, Sweden

    Jan-Erik Karlsson, Anders Björkholm, Peter Blomstrand, Jan Ohlsson & Lars Wallentin

Authors
  1. Jan-Erik Karlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anders Björkholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Blomstrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Ohlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lars Wallentin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karlsson, JE., Björkholm, A., Blomstrand, P. et al. 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. Int J Cardiac Imag 9, 281–289 (1993). https://doi.org/10.1007/BF01137155

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01137155

Key words

Search

Navigation