The role of the exercise test in the evaluation of patients for ischemic heart disease.

TLDR

The exercise test should be combined with other noninvasive tests to guide management of patients evaluated for ischemic heart disease. The study examined 1,472 patients who had exercise stress tests and coronary angiography within six weeks. In this cohort, exercise test parameters were diagnostically and prognostically valuable, with >97 % of Stage I/II positives showing significant coronary artery disease (over 60 % having three‑vessel disease and >25 % with left‑main stenosis), while Stage IV or greater with negative/indeterminate ST had <15 % three‑vessel and <1 % left‑main disease; additionally, a low‑risk subgroup (75 %) had >99 % 12‑month survival versus a high‑risk subgroup (11 %) with <85 %, confirming the exercise test as a noninvasive, reproducible tool for assessing anatomic disease and prognosis.

Abstract

A cohort of 1472 patients who underwent both exercise stress testing and coronary angiography within six weeks was examined. The data indicated that a combination of exercise parameters is both diagnostically and prognostically important. Almost all patients (greater than 97%) who had positive exercise tests at Stage I or Stage II had significant coronary artery disease. More than half of these (greater than 60%) had three vessel disease and over 25% had significant narrowing (greater than 50%) of the left main coronary artery. Patients who achieved Stage IV or greater exercise durations with either negative or indeterminate ST-segment response had less than a 15% prevalence of three vessel disease and less than a 1% prevalence of left main coronary artery disease. A low risk subgroup (75% of all non-operated patients) was identified with a twelve month survival greater than 99%. A high risk subgroup (11% of all nonoperated patients) was identified with a twelve month survival of less than 85%. The exercise test is a noninvasive, reproducible method to assess the presence and extent of anatomic disease and the prognosis when significant disease has been defined. It should be used in conjunction with other noninvasive tests to determine optimal management in patients evaluated for ischemic heart disease.