- Abnormal findings on exercise ECG can predict need for later coronary revascularization and acute coronary event risk in stable angina, but coronary CT angiography (CTA) outperforms it.
Why this matters
- European guidance has deemphasized exercise ECG for assessing stable angina.
- Editorial: this post hoc analysis of the SCOT-HEART randomized controlled trial adjusted the original cohort so much that it should be viewed as “essentially an observational study” and expresses several other concerns about the study.
- The findings suggest that exercise ECG “still has value,” the editorial writer says.
- Exercise ECG had 39% sensitivity and 91% specificity for detecting obstructive coronary artery disease (CAD) in patients who later had revascularization.
- Abnormal exercise ECG findings were linked to:
- 14.47-fold increased 1-year coronary revascularization (P<.001>
- 2.57-fold increased coronary heart disease mortality/nonfatal myocardial infarction at 5 years (P<.001>
- For 5-year coronary heart disease mortality/nonfatal myocardial infarction: 10.63 (P=.002).
- For 5-year nonobstructive CAD: 5.32 (P=.03).
- Original SCOT-HEART involved 12 cardiology chest pain clinics in Scotland, from November 18, 2010 to September 24, 2014.
- Current analysis included 3283 patients from original trial.
- Funding: Scottish Government; British Heart Foundation; others.
- Post hoc analysis.
- Findings are “hypothesis generating,” the authors say.
- Exercise ECG was not randomized.