Hossack K F, Bruce R A, Fisher L, Hofer V
Int J Cardiol. 1983 Apr;3(1):37-50. doi: 10.1016/0167-5273(83)90059-1.
Of 551 men with atypical chest pain enrolled in the Seattle Heart Watch Study, annual follow-up over a 5- to 10-year period identified 36 persons who experienced a primary coronary heart disease event. Only three events were fatal, and they were in men over the age of 50. Cox's regression model confirmed a significant association of the conventional risk factors of smoking (P = 0.03), elevated resting systolic blood pressure (P = 0.02) and hypercholesterolemia (P = 0.03) with primary coronary heart disease events. A count of these three variables was highly predictive (P = 0.002). A positive family history was not predictive. Functional aerobic impairment (P = 0.002) and ST depression (P = 0.0003) were the most useful exercise predictors. In men who had neither risk factors nor abnormal exercise predictors, the percentage free of coronary events at 9 years was 96% compared to 76% in men with one or more of the abnormal exercise findings (P less than 0.0001). Of men with only risk factors, 86% remained free of events at 9 years. This study demonstrates that the evaluation of both risk factors and exercise responses enhances the prognostic evaluation of men with atypical chest pain. The classification of men into low-, medium- and high-risk groups can be easily accomplished in office practice.
在参加西雅图心脏观察研究的551名非典型胸痛男性中，经过5至10年的年度随访，确定有36人发生了原发性冠心病事件。只有3例事件是致命的，且均发生在50岁以上的男性中。考克斯回归模型证实，吸烟（P = 0.03）、静息收缩压升高（P = 0.02）和高胆固醇血症（P = 0.03）这些传统风险因素与原发性冠心病事件之间存在显著关联。这三个变量的计数具有高度预测性（P = 0.002）。阳性家族史没有预测价值。功能性有氧能力受损（P = 0.002）和ST段压低（P = 0.0003）是最有用的运动预测指标。在既没有风险因素也没有异常运动预测指标的男性中，9年时无冠心病事件的比例为96%，而在有一项或多项异常运动表现的男性中这一比例为76%（P < 0.0001）。在仅有风险因素的男性中，86%在9年时仍无事件发生。这项研究表明，对风险因素和运动反应进行评估可增强对非典型胸痛男性的预后评估。在门诊实践中可以很容易地将男性分为低、中、高风险组。
