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Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65%

Background: The prognosis of patients with chest pain after a negative exercise test is good, but some adverse events occur in this low-risk group. The aim of our study was to identify predictors of long-term adverse events after a negative exercise test in patients with chest pain and a lower inter...

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Autores principales: Giga, Vojislav, Boskovic, Nikola, Djordjevic-Dikic, Ana, Beleslin, Branko, Nedeljkovic, Ivana, Stankovic, Goran, Tesic, Milorad, Jovanovic, Ivana, Paunovic, Ivana, Aleksandric, Srdjan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10341283/
https://www.ncbi.nlm.nih.gov/pubmed/37443623
http://dx.doi.org/10.3390/diagnostics13132229
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author Giga, Vojislav
Boskovic, Nikola
Djordjevic-Dikic, Ana
Beleslin, Branko
Nedeljkovic, Ivana
Stankovic, Goran
Tesic, Milorad
Jovanovic, Ivana
Paunovic, Ivana
Aleksandric, Srdjan
author_facet Giga, Vojislav
Boskovic, Nikola
Djordjevic-Dikic, Ana
Beleslin, Branko
Nedeljkovic, Ivana
Stankovic, Goran
Tesic, Milorad
Jovanovic, Ivana
Paunovic, Ivana
Aleksandric, Srdjan
author_sort Giga, Vojislav
collection PubMed
description Background: The prognosis of patients with chest pain after a negative exercise test is good, but some adverse events occur in this low-risk group. The aim of our study was to identify predictors of long-term adverse events after a negative exercise test in patients with chest pain and a lower intermediate (15–65%) pre-test probability of coronary artery disease (CAD) and to assess the prognostic value of exercise electrocardiography and exercise stress echocardiography in this group of patients. Methods: We identified from our stress test laboratory database 862 patients with chest pain without previously known CAD and with a pre-test probability of CAD ranging from 15 to 65% (mean 41 ± 14%) who underwent exercise testing. Patients were followed for the occurrence of death, non-fatal myocardial infarction (MI) and clinically guided revascularization. Results: During the median follow-up of 94 months, 87 patients (10.1%) had an adverse event (AE). A total of 30 patients died (3.5%), 23 patients suffered non-fatal MI (2.7%) and 34 patients (3.9%) had clinically guided revascularization (20 patients percutaneous and 14 patients surgical revascularizations). Male gender, age, the presence of diabetes and a slow heart rate recovery (HRR) in the first minute after exercise were independently related to the occurrence of AEs. Adverse events occurred in 10.3% of patients who were tested by exercise stress echocardiography and in 10.0% of those who underwent stress electrocardiography (p = 0.888). Conclusion: The risk of AEs after negative exercise testing in patients with a pre-test probability of CAD of 15–65% is low. Male patients with a history of diabetes and slow HRR in the first minute after exercise have an increased risk of an adverse outcome.
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spelling pubmed-103412832023-07-14 Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65% Giga, Vojislav Boskovic, Nikola Djordjevic-Dikic, Ana Beleslin, Branko Nedeljkovic, Ivana Stankovic, Goran Tesic, Milorad Jovanovic, Ivana Paunovic, Ivana Aleksandric, Srdjan Diagnostics (Basel) Article Background: The prognosis of patients with chest pain after a negative exercise test is good, but some adverse events occur in this low-risk group. The aim of our study was to identify predictors of long-term adverse events after a negative exercise test in patients with chest pain and a lower intermediate (15–65%) pre-test probability of coronary artery disease (CAD) and to assess the prognostic value of exercise electrocardiography and exercise stress echocardiography in this group of patients. Methods: We identified from our stress test laboratory database 862 patients with chest pain without previously known CAD and with a pre-test probability of CAD ranging from 15 to 65% (mean 41 ± 14%) who underwent exercise testing. Patients were followed for the occurrence of death, non-fatal myocardial infarction (MI) and clinically guided revascularization. Results: During the median follow-up of 94 months, 87 patients (10.1%) had an adverse event (AE). A total of 30 patients died (3.5%), 23 patients suffered non-fatal MI (2.7%) and 34 patients (3.9%) had clinically guided revascularization (20 patients percutaneous and 14 patients surgical revascularizations). Male gender, age, the presence of diabetes and a slow heart rate recovery (HRR) in the first minute after exercise were independently related to the occurrence of AEs. Adverse events occurred in 10.3% of patients who were tested by exercise stress echocardiography and in 10.0% of those who underwent stress electrocardiography (p = 0.888). Conclusion: The risk of AEs after negative exercise testing in patients with a pre-test probability of CAD of 15–65% is low. Male patients with a history of diabetes and slow HRR in the first minute after exercise have an increased risk of an adverse outcome. MDPI 2023-06-30 /pmc/articles/PMC10341283/ /pubmed/37443623 http://dx.doi.org/10.3390/diagnostics13132229 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Giga, Vojislav
Boskovic, Nikola
Djordjevic-Dikic, Ana
Beleslin, Branko
Nedeljkovic, Ivana
Stankovic, Goran
Tesic, Milorad
Jovanovic, Ivana
Paunovic, Ivana
Aleksandric, Srdjan
Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65%
title Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65%
title_full Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65%
title_fullStr Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65%
title_full_unstemmed Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65%
title_short Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65%
title_sort heart rate recovery as a predictor of long-term adverse events after negative exercise testing in patients with chest pain and pre-test probability of coronary artery disease from 15% to 65%
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10341283/
https://www.ncbi.nlm.nih.gov/pubmed/37443623
http://dx.doi.org/10.3390/diagnostics13132229
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