Exercise-Induced Ischemia in Mildly Symptomatic Patients with Coronary-Artery Disease and Preserved Left Ventricular Function: Identification of Subgroups at Risk of Death during Medical Therapy

R. O. Bonow*, K. M. Kent, D. R. Rosing, K. K. Lan, E. Lakatos, J. S. Borer, S. L. Bacharach, M. V. Green, S. E. Epstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

165 Scopus citations

Abstract

To determine prospectively whether the severity of reversible left ventricular ischemia provides prognostic information in mildly symptomatic patients with coronary-artery disease and preserved left ventricular function at rest (ejection fraction greater than 40 percent), we studied 117 patients by means of exercise electrocardiography and radionuclide angiography. No patient had stenosis of the left main coronary artery. Mortality during subsequent medical therapy was significantly associated (by univariate life-table analysis) with three-vessel coronary-artery disease and the magnitude of the ejection fraction during exercise. In patients with three-vessel disease who had both ST-segment depression of 1 mm or more and a decrease in ejection fraction during exercise, in association with an exercise tolerance of 120 W or less, the probability of survival at four years was only 71 ±11 percent (S.E.). All deaths occurred in this subgroup. Thus, objective evidence of left ventricular ischemia during exercise and exercise capacity identify one subgroup of minimally symptomatic patients with three-vessel disease with an excellent prognosis and another subgroup at relatively high risk of dying during subsequent medical therapy. (N Engl J Med 1984; 311: 1339–45.).

Original languageEnglish (US)
Pages (from-to)1339-1345
Number of pages7
JournalNew England Journal of Medicine
Volume311
Issue number21
DOIs
StatePublished - Nov 22 1984

ASJC Scopus subject areas

  • Medicine(all)

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