Sato I
Department of Cardiovascular Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
Hokkaido Igaku Zasshi. 1989 Nov;64(6):749-60.
The prognostic value of the exercise testing as well as coronary risk factors was assessed in 890 patients (pts) with a history of myocardial infarction (MI, n = 114) or chest pain (typical angina; TA, n = 134, others; OTH, n = 642) in relation to cardiac events (cardiac death, non-fatal MI). Clinical questionnaires and symptomatic-maximal graded treadmill exercise were performed in all pts. Follow-up was obtained prospectively by mail or telephone interview annually. Twenty eight pts were lost to follow-up. In the remaining 862 pts (96.9%), the mean follow-up duration was 3.1 +/- 1.4 (mean +/- SD) years. During follow-up period, 39 cardiac events (21 cardiac death, 18 non-fatal MI) (4.5%) occurred. Cardiac event rates in pts with MI, TA, and OTH were 16.2%, 9.8%, and 1.3%, respectively. Univariate analyses revealed that the event rate was influenced by age, sex (male), hypertension, diabetes mellitus, and HDL-cholesterol among coronary risk factors, and by anginal pain during exercise, ST depression, poor exercise tolerance, and abnormal blood pressure response among treadmill exercise findings. By Cox proportional hazard model analysis, the history of MI, age, TA, and ST depression (within 6 minutes of Bruce protocol) was significantly independent predictors for future cardiac events in all pts; and age, sex, and TA in pts without MI. In conclusion, the exercise testing combined with conventional coronary risk factor analysis was effective means in predicting future cardiac events.
在890例有心肌梗死(MI,n = 114)或胸痛病史(典型心绞痛;TA,n = 134,其他;OTH,n = 642)的患者中,评估运动试验以及冠状动脉危险因素与心脏事件(心源性死亡、非致死性心肌梗死)的预后价值。对所有患者进行了临床问卷调查和症状性最大分级平板运动试验。通过每年邮寄或电话访谈进行前瞻性随访。28例患者失访。在其余862例患者(96.9%)中,平均随访时间为3.1±1.4(均值±标准差)年。在随访期间,发生了39例心脏事件(21例心源性死亡,18例非致死性心肌梗死)(4.5%)。MI、TA和OTH患者的心脏事件发生率分别为16.2%、9.8%和1.3%。单因素分析显示,在冠状动脉危险因素中,事件发生率受年龄、性别(男性)、高血压、糖尿病和高密度脂蛋白胆固醇影响;在平板运动试验结果中,受运动时心绞痛、ST段压低、运动耐量差和血压反应异常影响。通过Cox比例风险模型分析,MI病史、年龄、TA和ST段压低(Bruce方案6分钟内)是所有患者未来心脏事件的显著独立预测因素;在无MI的患者中,年龄、性别和TA是预测因素。总之,运动试验结合传统冠状动脉危险因素分析是预测未来心脏事件的有效手段。