Underestimating the Risk of an Inconclusive Result in Exercise Treadmill Tests for Patients With Suspected Ischemic Heart Disease

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  • Lin Wei-Chen
    Institute of Clinical Medicine, College of Medicine, National Cheng Kung University Department of Medicine, College of Medicine, National Cheng Kung University
  • Huang Mu-shiang
    Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Department of Statistics, College of Management, National Cheng Kung University
  • Liu Ping-Yen
    Institute of Clinical Medicine, College of Medicine, National Cheng Kung University Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University

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<p>Background: The exercise stress test is a widely used noninvasive test for diagnosing ischemic heart disease. Patients with a “positive” result have a higher risk than those with a “negative” result. However, the outcomes of patients with an “inconclusive” result remain uncertain.</p><p>Methods and Results: We retrospectively collected the data of patients who underwent an ECG-based treadmill stress test between August 2009 and March 2020. Propensity score matching (PSM) was performed to adjust for confounders. Clinical outcomes were compared in terms of all-cause death and cardiovascular (CV) death. Subgroup analysis evaluated treatment interactions, including medication and examinations. In total, 25,475 patients were recruited, and after exclusion and PSM, 4,847 (1,621 with a positive result, 1,606 with a negative result, and 1,621 with an inconclusive result) remained. Compared with the negative group, the inconclusive group, but not the positive group, had a significantly worse outcome in terms of all-cause death (hazard ratio [HR]: 1.834, 95% confidence interval [CI]: 1.34–2.511 and HR: 1.327, 95% CI: 0.949–1.857, respectively); however, CV death was not significantly different in the inconclusive and positive groups (HR: 1.728, 95% CI: 0.413–7.232 and HR: 2.067, 95% CI: 0.517–8.264, respectively).</p><p>Conclusions: Clinicians must not underestimate the potential for worse outcomes in patients with an inconclusive stress test result.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 87 (2), 368-375, 2023-01-25

    一般社団法人 日本循環器学会

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