[Usefulness of clinical profiling and exercise testing in the prognostic assessment of patients admitted with chest pain but without high-risk criteria]. / Utilidad del perfil clínico y la ergometría en la valoración del pronóstico de los pacientes ingresados por dolor torácico sin criterios de alto riesgo.

INTRODUCTION AND OBJECTIVES: Few data are available on the outcome of patients admitted to hospital with suspected acute coronary syndrome who have no high-risk factors and who undergo exercise testing before discharge. Our objectives were to investigate outcomes in this group of patients and to determine whether clinical history-taking or exercise testing can help to predict outcome. PATIENTS AND METHOD: The study population comprised 449 patients admitted to hospital with chest pain suggestive of acute coronary syndrome. All were judged to be at a low risk of subsequent events (i.e., none had ischemic ECG changes or an elevation in troponin level). They underwent treadmill exercise testing before discharge, after an observation period of at least 12 hours. Exercise testing was performed after clinical evaluation based on an algorithm involving troponin-T level and resting ECG. The median follow-up duration was 479 days. The single combined endpoint was defined as cardiac death, or hospital admission for nonfatal acute myocardial infarction or unstable angina. RESULTS: Adverse events occurred in 44 (10%) of the 449 patients. A high event rate was associated with four clinical features (i.e., age > or =65 years, diabetes, previous acute myocardial infarction, and typical chest pain) and with a positive result on exercise testing. CONCLUSIONS: Adverse events after discharge are not infrequent in patients admitted to hospital with suspected acute coronary syndrome and a low risk profile. Both the patient's clinical characteristics and exercise test results should be taken into account in accurately determining prognosis.

[Dobutamine stress echocardiography in patients with stable chronic angina and a low- or medium-risk on exercise testing: usefulness for assessing long-term prognosis]. / Ecocardiografía con dobutamina en pacientes con angina crónica estable y ergometría de riesgo bajo o intermedio: utilidad en la valoración del pronóstico a largo plazo.

INTRODUCTION AND OBJECTIVES: The ability of stress echocardiography to provide prognostic information that supplements that obtainable from clinical data and exercise electrocardiography is still controversial. Our aim was to determine whether dobutamine stress echocardiography provides additional information on long-term prognosis after conventional exercise testing has indicated that a patient with chronic stable angina has a low or intermediate risk of a cardiac event. PATIENTS AND METHOD: The study included consecutive patients with stable angina who were not found to be at high risk on a previous exercise test. All patients underwent dobutamine stress echocardiography. The mean follow- up period was 4.5+/-1.76 years. The single combined end-point was defined as death due to cardiac disease, nonfatal myocardial infarction, or hospitalization for unstable angina. Multivariate analysis was used to identify independent predictors of cardiac events. RESULTS: There were 24 (19%) cardiac events in the 124 participants: four deaths due to cardiac disease, 10 nonfatal myocardial infarctions, and 10 hospitalizations for unstable angina. Associations were found between a higher event rate during follow-up and previous myocardial infarction, Duke treadmill score, and the detection of regional wall motion abnormalities indicative of multivessel disease by stress echocardiography. CONCLUSIONS: In patients with stable angina who have undergone an exercise test that indicates that they have a low or intermediate risk of cardiac events, dobutamine stress echocardiography provides additional prognostic information to that obtainable from clinical data and exercise testing.