The exercise test that indicates a low risk of events. Differences in prognostic significance between patients with chronic stable angina and patients with unstable angina.

OBJECTIVES: The objective of this prospective study was to determine the differences in the prognostic significance of an exercise test (ET) that indicates a low risk of events (low-risk exercise test [LRET]) between patients with unstable angina (UA) and those with chronic stable angina (CSA). BACKGROUND: It is not known whether the prognostic significance of an LRET is influenced by the disease; that is the reason for performing exercise testing. METHODS: All patients not presenting with high-risk criteria were submitted to a prognostic ET. The ET was performed by patients with CSA and patients with primary UA stabilized with medical therapy. Medical therapy was planned for all patients. A combined end point was defined as cardiac death, nonfatal acute myocardial infarction or hospital admission for UA. Multivariate analysis was performed to determine the independent predictors of events. RESULTS: Low-risk criteria were fulfilled by 105 patients with UA and 86 patients with CSA. The mean follow-up time was 347 +/- 229 days. The event rate was higher in the UA group than in the CSA group (28% vs. 9%, p = 0.001). The CSA group showed worse ET results. Performance of ET by patients with UA was the principal predictor of events (odds ratio 4.2, p = 0.0005). CONCLUSIONS: Among patients who underwent an LRET, those with UA had a rate of events significantly higher than that of patients with CSA, despite the worse results of ET in patients with CSA.

[Atypical chest pain with normal coronary vessels: clinical study and follow-up of 22 patients]. / Dolor torácico atípico con coronarias normales: estudio clínico y seguimiento de 22 pacientes.

22 patients with normal coronarography but with angina pectoris or angina-like chest pain without evidence of coronary spasms are reviewed. We studied clinical characteristics, basal and exercise electrocardiography and other tests used to obtain a diagnosis, although only in one patient were we able to find an esophageal pathology which caused the clinical picture. After 20.7 +/- 14.4 months follow-up no patients had myocardial infarction or acute coronary events. Most of them still experience chest pain, are physically limited and use antianginal drugs. The fact that their coronarograms were normal decreased significantly the number of admissions to hospital (2.4 +/- 3.3 vs 0.26 +/- 0.95, P less than 0.02) and the amount of drugs prescribed. The lack of improvement of most of them seems to justify the need for other studies looking for a positive diagnosis and other types of treatment.