Exercise ECG and case history in the diagnosis of latent coronary heart disease among presumably healthy middle-aged men.

Previously undetected coronary heart disease (CHD) was suspected in 152 of 2014 presumably healthy males aged 40-59 yr. 63 had angina pectoris, 100 a positive exercise test and only 13 both angina and a positive exercise test. Coronary angiography was performed in 105 cases of whom 69 had a positive angiogram. A 2:1 proportion of true vs false positive diagnoses of CHD was found regardless of whether the diagnosis was suspected by the exercise test and/or the case history. Exercise test data show that CHD-suspect individuals differ only marginally from normal age counterparts irrespective of angiographic findings. However, of the 12 with a positive exercise ECG and maximal pulse greater than or equal to 2 SD below normal mean, 10 had pathologic angiograms. Of 58 with positive exercise ECGs and pathological angiograms, 43 had work performance below normal mean. By using a target pulse of 150 beats/minute 69% of the positive exercise ECGs had remained undisclosed.