Survival with painless strongly positive exercise electrocardiogram

Abstract

To determine the prognosis of patients with painless strongly positive exercise electrocardiogram, the 6-year cumulative survival rate was computed for 298 medically treated patients who terminated their exercise test with or without angina. All had horizontal or downsloping ST depression ≥2 mm during a treadmill exercise test according to the standardized multistage Bruce protocol. Of the 298 patients, 119 terminated the exercise test because of dyspnea or fatigue and 179 stopped because of angina. Among the 119 patients without angina, there were 18 deaths, 16 from coronary artery disease (CAD), of which 8 occurred suddenly. Among the 179 patients with exercise-induced angina, 36 died, 33 from CAD, of which 13 were sudden deaths. The overall 6-year survival rate was 85 ± 3% for patients without angina and 80 ± 3% in those with angina (p < 0.05). However, patients without angina achieved a significantly longer duration of exercise and had higher maximal heart rate and systolic blood pressure during exercise. In both groups, survival decreased with decreasing duration of exercise. In patients without angina, the 6-year survival rate was 97 ± 3% in those achieving stage IV (≥541 s), 87 ± 4% in stage III (361 to 540 s), 64 ± 13% in stage II (181 to 360 s) and 60 ±15% in stage I (≤180 s). In patients with exercise-induced angina, the 6-year survival rate was 100% in stage IV, 94 ± 3% in stage III, 80 ± 4% in stage II and 44 ± 10% in stage I. Thus, patients with painless strongly positive exercise electrocardiogram have causes of death similar to patients with induced angina and their survival rate also varies according to their exercise duration.