Value and limitations of the electrocardiographic response to exercise in the assessment of patients with coronary artery disease. Controversies in cardiology--II.

The results of exercise testing provide a probabibity statement rather than a definitive answer regarding the existence of coronary disease. Moreover, in asymptomatic subjects (1) the S-T segment response to exercise testing has a relatively poor predictive accuracy, (2) exercise testing does not appear to be a practical screening method for detecting subjects at high risk of sudden death, and (3) risk factors should be vigorously treated regardless of the results of screening studies for coronary artery disease. Hence, the probability statements derived from the electrocardiographic response to exercise testing do not appear to provide important enough diagnostic or prognostic information to justify routine use in asymptomatic subjects. Although exercise screening studies provide only marginal aid in detection coronary artery disease in symptomatic patients, important prognostic information may be derived that could influence decisions regarding pharmacologic or surgical therapy. Thus, although electrocardiographic stress testing should not be used as a routine screening procedure, its judicious use in symptomatic patients may provide the physician with important information for patient management.