Reassessing the value of the exercise electrocardiogram in the diagnosis of stable chest pain

Title: Reassessing the value of the exercise electrocardiogram in the diagnosis of stable chest pain
Author(s): Bourdillon, PJ
Item Type: Chapter
Abstract: Background: doubt has been expressed about the value of exercise electrocardiography (ECG) in the diagnosis of coronary artery disease (CAD). This paper tests the diagnostic impact of 2 strategies for analysing ST segment depression. Methods: 7739 consecutive patients referred to a rapid access chest pain clinic from primary care between January 1999 and March 2010 were studied. The pre-exercise probability of coronary artery disease (pCAD) was determined from symptoms and risk factors using the methodology of the UK National Institute for Health and Clinical Excellence (NICE). The post-exercise pCAD was calculated: firstly, using NICE’s sensitivity of 67% and specificity of 69% for the exercise ECG, and secondly using a published set of 6 sensitivities and specificities that vary according to the amount of ST segment shift on exercise. Pre- and post-exercise pCADs were grouped according to NICE’s categories: CAD ruled out, suitable for non-invasive testing, candidate for coronary arteriography, and CAD ruled in. Results: 2910 of the 5157 patients exercised were in the ‘suitable for non-invasive testing’ category. With NICE’s single combination of sensitivity and specificity, 793 (27.3%) of the 2910 had CAD ruled out and 128 (4.4%) became candidates for coronary arteriography. With 6 combinations of sensitivity and specificity, 1383 (47.5%) of the 2910 had CAD ruled out and 48 (1.6%) CAD ruled in, while another 170 (5.8%) became candidates for coronary arteriography. Conclusion: the exercise ECG has considerable diagnostic value if it is assumed that the greater the ST segment shift the greater the likelihood of CAD.
Content Version: Published version
Editor(s): Gaze D
Publication Date: 31-Mar-2012
Publisher Link:
ISBN: 978-953-51-0262-5
Publisher: InTech - Open Access Publisher
Presented At: Coronary Artery Disease - Current Concepts in Epidemiology, Pathophysiology, Diagnostics and Treatment
Chapter: 9
Start Page: 171
End Page: 182
Place of Publication: Rijeka, Croatia
Copyright Statement: © 2012 The Authors
Appears in Collections:Vascular Science

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