Chest Pain in a 67-Year-Old Patient
A 67-year-old woman presented to her cardiologist with complaints of episodes of chest discomfort. The patient was a current smoker (1 pack per day for 20 years), with a medical history of hypertension and dyslipidemia. Her medication regimen included rosuvastatin 5 mg and enalapril 10 mg daily. She had been suffering from increasing chest discomfort for the past 1-2 years. At first, she noticed the discomfort only when she experienced extreme exertion, such as running for the bus, and these symptoms always promptly resolved when she stopped or slowed down. About 6 months ago, she noted that the chest pain episodes had become more frequent and provoked by physical efforts such as walking up a flight of stairs or two blocks down the street; again, they always resolved with rest. On examination, blood pressure and heart rate were 132/68 mmHg and 65 bpm, respectively. Electrocardiogram at rest showed sinus rhythm without any repolarization abnormalities. Resting transthoracic echocardiography showed a wall motion abnormality in the inferior wall with a left ventricular (LV) ejection fraction of 52%. Stress echocardiography was performed and disclosed wall thickening abnormalities affecting the interventricular septum and entire inferior wall. The patient was diagnosed with stable angina, discharged on guidelines-directed medical therapy, and was referred for coronary angiography. The latter showed severe stenosis of the right coronary artery.
Which of the following characteristics is the most accurate to predict adverse outcomes in this patient with stable angina?