Exercise stress testing

The lay press is all over this study, blaring out this headline: Stress Test May Miss Early Heart Disease. Here were the participants in the study:

Most were men over 45 or women over 55, smokers, people with high cholesterol or high blood pressure, diabetes or a close relative with early heart disease, they reported in this week’s issue of the Journal of the American College of Cardiology.

The 1,195 patients in the study had no evidence of heart disease, had stress tests and then a procedure called coronary calcium scanning within six months.

One should take into consideration that it is already known that the sensitivity of exercise stress testing in asymptommatic patients is relatively low. From UptoDate:

A meta-analysis of 147 published reports including over 24,000 patients compared the test performance of exercise ECG testing (compared to angiography) in patients with an intermediate pretest risk (25 to 75 percent) of CHD [5,6]. The overall sensitivity and specificity of exercise ECG testing were 68 and 77 percent, respectively; comparable values (67 and 72 percent) were obtained when patients with a prior myocardial infarction were excluded [5].

Exercise stress testing is not meant for those without symptoms, as evidenced by the recent USPSTF guidelines. Of course it is going to suffer in comparison to coronary calcium scores, and this study isn’t really reporting anything new.

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