Superiority of exercise myocardial perfusion imaging compared with the exercise ECG in the diagnosis of coronary artery disease.

Publication/Presentation Date

9-1-2008

Abstract

BACKGROUND: Wide variations in the sensitivity and specificity of the exercise ECG for the diagnosis of coronary artery disease (CAD) have been reported. The aim of this study was to reexamine the sensitivity and specificity of the stress ECG and stress myocardial perfusion imaging (MPI) relative to cardiac catheterization in an era of aggressive screening.

METHODS AND RESULTS: We evaluated 218 patients [mean age: 62+/-13 (SD) years; 69% males] with symptoms of chest pain or dyspnea, normal resting ECGs, and no earlier myocardial infarction. All patients exercised to age-corrected and sex-corrected Bruce protocol times and achieved >or=85% of predicted maximum heart rate. Coronary angiography was performed within 3 months of stress testing. Sixty-six percent of patients had significant CAD by angiography. The overall sensitivity of the exercise ECG (36%) was significantly lower than that of exercise MPI (81%) (Por=70%, the sensitivity of the exercise ECG was higher (58%), but still less than MPI (88%) (P<0.01).

CONCLUSION: MPI is vastly superior to the stress ECG for the diagnosis of CAD, especially in patients with single-vessel CAD. Older literature reporting higher sensitivity for the stress ECG was likely biased by patients with more severe CAD and must be reexamined in the era of earlier diagnosis and intervention.

Volume

19

Issue

6

First Page

399

Last Page

404

ISSN

0954-6928

Disciplines

Medicine and Health Sciences

PubMedID

18955833

Department(s)

Department of Medicine

Document Type

Article

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