Rapid recovery on exercise ECG may obviate need for more tests

9 feb 2014—Additional testing for ischemic heart disease is less likely to yield benefit in those with rapid recovery of electrocardiographic (ECG) changes on the exercise treadmill test (ETT), according to research published online Feb. 5 in the Journal of the American College of Cardiology.

Mitalee P. Christman, of Harvard Medical School in Boston, and colleagues analyzed data from 3,345 consecutive patients without known coronary artery disease who were referred for clinical ETT at a large medical center. The researchers sought to estimate the frequency and results of downstream testing following ETT.

The researchers found that, following ETT, 9.0 percent underwent noninvasive imaging and 2.3 percent were referred directly to invasive angiography. Rapid recovery of ECG changes during ETT was associated with excellent prognosis and low yield of downstream testing. Typical angina, despite negative ETT, was associated with worse prognosis and higher yield of downstream testing. Predictors of negative downstream tests included younger age, female gender, higher metabolic equivalents of task achieved, and rapid recovery of ECG changes.

"These data provide important feedback; at the margins, the exercise ECG remains a useful initial strategy for the risk stratification of individuals suspected of ischemic heart disease," write the authors of an accompanying editorial.

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