A Double Master's Two-Step Test: Clinical, Angiographic and Hemodynamic Correlations

Abstract

One hundred and sixty men, of 41.6 years mean age, with known or suspected coronary artery disease, including, for the majority, a history of angina or myocardial infarction, or both, had double Master's two-step tests and selective coronary angiograms. Eighty-seven of these also had hemodynamic studies involving cardiac catheterization. Ninety subjects had no cardiac symptoms during the 3 months preceding study; the others had chest pain, in most cases considered to be angina. Angiographic findings were graded by degree of stenosis of major coronary arteries. Comparison of step-test results with coronary angiograms showed 16% "false positive" responses in subjects without evidence of coronary disease and 33% "false negative" tests in patients with severe obstructive coronary atherosclerosis. Relating step-test results to hemodynamic findings gave similar results. Evidence of serious coronary stenosis is found in many asymptomatic subjects, frequently in association with negative step tests. The double Master's two-step test yields an unacceptable number of "false positive" results. The prevalence of "false negative" results indicates that reliance on the test in excluding the presence of even grave coronary artery disease is unwarranted.