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Prognostic value of electrocardiogram exercise testing for risk stratification in asymptomatic coronary artery disease

Guerreiro, Sara L.; Ferreira, Jorge M.; Calqueiro, João M.; Mendes, Miguel S.

doi: 10.1097/MCA.0000000000000526
Original Research

Background Several variables of electrocardiogram exercise testing (EET) predict cardiovascular events in the general population and in patients with coronary artery disease (CAD). However, most of the studies have not included patients with asymptomatic CAD. The aim of this study was to evaluate the prognostic value of EET in asymptomatic CAD patients.

Patients and methods We carried out a retrospective single-center analysis including all patients with asymptomatic CAD documented by angiography who underwent EET from January 2010 to December 2013. A number of EET variables and three exercise scores [Duke Treadmill Score (DTS), Morise score, and FIT score] were analyzed. The primary endpoint was the combined incidence of myocardial infarction (MI), myocardial revascularization, and death from any cause during follow-up.

Results A total of 306 patients were included (mean age was 65±10 years, 61% had previous MI, and the median exercise capacity was 9.4±2.7 metabolic equivalent of task). The primary endpoint occurred in 15.7% of patients during 3.3 years of follow-up. The DTS and FIT were independent predictors of the primary endpoint unlike the Morise score (DTS: hazard ratio=0.91, 95% confidence interval: 0.85–0.99, P=0.018; FIT score: 0.99, 0.98–0.996, P=0.001; Morise score: 0.97, 0.93–1.02, P=0.20). The DTS was independent predictor of MI or revascularization, whereas FIT predicted death from any cause. Excluding patients with early revascularization, DTS had no predictive power at the composite endpoint.

Conclusion In our population with asymptomatic CAD, FIT and DTS had significant value for risk prediction and consequently the EET can be a valid tool in the clinical follow-up of this population.

Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal

Correspondence to Sara L. Guerreiro, MD, Avenida Conselheiro Ferreira Lobo, n°22; 1° Esquerdo, 2760-030 Caxias, Portugal Tel: +351 968 895 708; fax: +351 214 188 095; e-mail:

Received March 5, 2017

Received in revised form June 6, 2017

Accepted June 12, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.