COMPARISON OF EXERCISE STRESS-TESTING WITH AMBULATORY ELECTROCARDIOGRAPHIC MONITORING IN THE DETECTION OF MYOCARDIAL-ISCHEMIA AFTER UNSTABLE ANGINA-PECTORIS

Exercise testing, considered to be contraindicated in unstable angina,1 has recently been reported to be safe in patients whose symptoms have stabilized on medical therapy,2 although this is not uniformly accepted.3 Abnormal exercise responses in patients with recently stabilized unstable angina are associated with more extensive coronary artery disease4 and a worse prognosis.3,5 Detection of ischemia on continuous electrocardiographic (ECG) recordings performed early during hospitalization for unstable angina has been shown to indicate an adverse prognosis.6-10 Preliminary data suggest that continuing silent myocardial ischemia detected by ambulatory ECG monitoring at the time of hospital discharge also denotes an adverse prognosis,11 but there are no studies comparing exercise testing with ambulatory monitoring. In this study we compared exercise testing and ambulatory monitoring for the detection of myocardial ischemia in 32 medically stabilized patients at discharge after hospitalization for unstable angina pectoris. © 1991.