title: Clinical utility of the exercise ECG in patients with diabetes and chest pain.
abstract: OBJECTIVE
  The purpose of this study was to determine the characteristics of exercise treadmill testing in diabetic patients presenting with chest pain.
  
  
  BACKGROUND
  The diagnosis of coronary artery disease (CAD) in diabetic patients is confounded by different manifestations of coronary disease than are seen in the general population. Because of the association of diabetes with accelerated CAD, it is critical to assess the diagnostic utility of the standard exercise test in diabetic patients with chest pain.
  
  
  METHODS
  This study was a retrospective analysis of standard exercise test results in 1,282 male patients without prior myocardial infarction who had undergone coronary angiography and were being evaluated for possible CAD at two Veterans' Administration institutions.
  
  
  RESULTS
  In patients with diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 69%; the sensitivity of the exercise test was 47% (95% confidence interval [CI], 41 to 58), and specificity was 81% (95% CI, 68 to 89). In patients without diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 58%; the sensitivity of the exercise test was 52% (95% CI, 48 to 56), and specificity was 80% (95% CI, 76 to 83). The receiver operating characteristic curves were also similar in both diabetic and nondiabetic patients (0.67 and 0.68, respectively).
  
  
  CONCLUSIONS
  These data demonstrate that the standard exercise test has similar diagnostic characteristics in diabetic as in nondiabetic patients.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford 94305-5406, USA. dplee@leland.stanford.edu
authors.forename: D P
authors.initials: DP
authors.lastname: Lee
authors.forename: W F
authors.initials: WF
authors.lastname: Fearon
authors.forename: V F
authors.initials: VF
authors.lastname: Froelicher
mesh_terms: D002637:Chest Pain / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis*; D048909:Diabetes Complications; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity