Exercise testing in coronary artery disease with ST-segment abnormalities at rest.

In order to assess the diagnostic value of stress testing in patients with coronary artery disease (CAD) and ST abnormalities at rest, the results of a bicycle ergometer exercise, were compared in two groups of patients. Group 1 was composed of 58 CAD patients with normal resting ECG; group 2 was composed of 115 CAD subjects with abnormal ECG at rest. The latter group was then divided into three subgroups according to the absence (2a) or the presence (2b) of previous transmural myocardia infarction, or of previous transmural infarction with ST segment elevation at rest (3c). According to conventional exercise ECG criteria, the test was positive in 81% of group 1 and nearly in all the patients of group 2. In group 2 the prevalence of exercise-chest pain was constantly lower, particularly in subgroup 3c, in comparison with group 2. A greater prevalence of chest pain together with a greater severity of Gensini index were found in the subjects with positive exercise ECG in leads different from the impaired ones at rest. The diagnostic value of exercise ischemic changes location and of chest pain appearance, in patients with ST abnormalities at rest, is emphasized.