Exercise Stress Testing

TLDR

The study aimed to assess how coronary‑artery disease prevalence affects the diagnostic accuracy of stress testing by correlating chest pain classification, stress test outcomes, and coronary angiography in 2,045 patients. They analyzed 2,045 patients from a multicenter trial, correlating chest pain descriptions, stress test results, and coronary angiography findings. The study found that pre‑test risk varied widely (7–87 %) and that stress test results only modestly altered risk (positive +6–20 %, negative –2–28 %), with false‑positive rates differing by sex but not when prevalence was matched, concluding that stress testing has limited predictive value in heterogeneous populations.

Abstract

To determine to what extent the diagnostic accuracy of stress testing is influenced by the prevalence of coronary-artery disease, we correlated the description of chest pain, the result of stress testing and the results of coronary arteriography in 1465 men and 580 women from a multicentered clinical trial. The pre-test risk (prevalence of coronary-artery disease) varied from 7 to 87 per cent, depending on sex and classification of chest pain. A positive stress test increased the pre-test risk by only 6 to 20 per cent, whereas a negative test decreased the risk by only 2 to 28 per cent. Aothough the percentage of false-positive results differed between men and women (12 +/- 1 per cent versus 53 +/- 3 per cent P less than 0.001), this difference was not seen in a subgroup matched for prevalence of coronary-artery disease. We conclude that the ability of stress testing to predict coronary-artery disease is limited in a heterogeneous population in which the prevalence of disease can be estimated through classification of chest pain and the sex of the patient.