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(Chest. 2004;125:1124-1131.)
© 2004 American College of Chest Physicians

Prognostic Value of Stress Testing in Patients Over 75 Years of Age With Chronic Angina*

Raban V. Jeger, MD; Michael J. Zellweger, MD; Christoph Kaiser, MD; Leticia Grize, PhD; Stefan Osswald, MD; Peter T. Buser, MD and Matthias E. Pfisterer, MD; for the TIME Investigators{dagger}

* From the Division of Cardiology (Drs. Jeger, Zellweger, Kaiser, Osswald, Buser, and Pfisterer), University Hospital Basel; and Institute of Epidemiology (Dr. Grize), University of Basel, Basel, Switzerland. {dagger} A list of all TIME investigators is contained in reference 14 .

Correspondence to: Matthias E. Pfisterer, MD, Principal Investigator TIME, Head, Division of Cardiology, University Hospital, CH-4031 Basel, Switzerland; e-mail: pfisterer{at}email.ch

Study objectives: To define the prognostic value of stress testing (STRT) in patients >= 75 years of age.

Design: Multicenter prospective randomized trial.

Setting: Tertiary care centers.

Patients: Two hundred ninety-two patients of the Trial of Invasive vs Medical Treatment of Elderly Patients aged >= 75 years with chronic angina despite receiving two or more antianginal drugs were prospectively observed for 1 year.

Intervention: STRT (88% exercise ECG; 12% pharmacologic stress imaging) was performed if possible, and ischemia was diagnosed using current guidelines. Death for any reason and nonfatal myocardial infarction were outcome events.

Results: Patients who could perform STRT (148 patients) were younger, had a lower risk profile, received less medication, and had less severe angina than patients who could not perform STRT (144 patients). The 1-year mortality rate was only 1.4% in patients with negative STRT results (72 patients) compared to 5.3% in patients with positive STRT results (76 patients) and 13.7% in patients who had not undergone STRT due to unstable symptoms (95 patients). The corresponding 1-year rates of death/infarction were 2.8%, 15.8%, and 26.3%, respectively. After adjustment for baseline differences, mortality rates were no longer significantly different. However, compared to patients with negative STRT results, infarction and death/infarction rates remained higher in patients with provocable ischemia (hazard ratio [HR], 8.9 [p = 0.04]; HR, 6.1 [p = 0.02], respectively) and in patients without STRT due to unstable angina (HR, 11.8 [p = 0.02]; HR, 8.6 [p = .004], respectively).

Conclusions: STRT in elderly patients is feasible and provides important prognostic information for their future management. Patients with negative STRT results after receiving therapy have a good prognosis, and their conditions may be managed conservatively.

Key Words: aging • angina pectoris • coronary disease • myocardial ischemia • prognosis • stress test






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