Home > General Cardiology > Journal Club 19 February 2014

Journal Club 19 February 2014


The Yield of Downstream Tests after Exercise Treadmill Testing: A Prospective Cohort Study





To estimate the frequency and results of downstream testing following exercise treadmill tests (ETT).


The utility of additional diagnostic testing following ETT is not well characterized.


We followed consecutive individuals without known CAD referred for clinical ETT at a large medical center. We measured the frequency and results of downstream imaging tests and invasive angiography within six months of ETT, and the combined endpoint of survival free from cardiovascular death, myocardial infarction, and coronary revascularization.


Among 3,345 consecutive subjects who were followed for a mean of 2.5±1.1 years, 332 (9.0%) underwent noninvasive imaging while 84 (2.3%) were referred directly to invasive angiography after ETT. The combined endpoint occurred in 76 (2.2%) patients. The annual incidence of the combined endpoint following negative, inconclusive and positive ETT was 0.2%, 1.3% and 12.4% respectively (P<0.001). Rapid recovery of ECG changes during ETT was associated with negative downstream test results and excellent prognosis while typical angina despite negative ECG was associated with positive downstream tests and adverse prognosis (P<0.001). Younger age, female gender, higher METs achieved and rapid recovery of ECG changes were predictors of negative downstream tests.


Among patients referred for additional testing after ETT, the lowest yield was observed among individuals with rapid recovery of ECG changes or negative ETT while the highest yield was observed among those with typical angina despite negative ECG or a positive ETT. These findings may be used to identify patients who are most and least likely to benefit from additional testing.

Categories: General Cardiology
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