Inducible Ischemia and the Risk of Recurrent Cardiovascular Events in Outpatients with Stable Coronary Heart Disease

Current physician guidelines do not recommend routine cardiac stress testing for patients with known heart disease. Previous studies, however, have shown that inducible ischemia is predictive of adverse cardiovascular events, whether it is accompanied by angina or not. Ischemia is an inadequate flow of blood to a part of the body, caused by constriction or blockage of the blood vessels. In this study, the researchers attempt to compare the risk of recurrent coronary heart disease (CHD) in outpatients with angina or inducible ischemia. Data were collected from 937 patients with known CHD who were participating in the Heart and Soul Study. Angina was assessed by questionnaire and ischemia by exercise stress echocardiography. Participants were followed for 3.9 years.

Key Findings:

  • The presence of angina did not predict myocardial infarction or CHD death.
  • The presence of ischemia was strongly associated with CHD events and participants with both angina and ischemia had the highest rate of CHD events.
  • The presence of ischemia alone was associated with a greater than twofold increased risk of recurrent CHD events.
  • Patients with inducible ischemia who underwent elective revascularization had a better prognosis, which means that an aggressive treatment strategy may be warranted.