title: Is exercise testing useful to improve the prediction of coronary events in asymptomatic subjects?
abstract: OBJECTIVE
  The value of exercise testing (ET) in asymptomatic subjects remains controversial and is unknown in countries with a low coronary heart disease (CHD) incidence. The aim of this study was to investigate the ability of ET to improve the prediction of a first coronary event in such a population.
  
  
  METHODS
  Using a prospective cohort study, 1051 consecutive healthy asymptomatic adults were enrolled in a cardiovascular screening program including ET. The pre-test risk of CHD was evaluated by the 10-year Framingham risk function. Positive ET was defined as a horizontal or downsloping ST-segment depression >/=1.0 mm. The primary outcome was total coronary events (CE) occurrence, including cardiac deaths, acute myocardial infarction and stable or unstable angina. The mean follow-up period was 6 years.
  
  
  RESULTS
  Subjects were aged 18-79 years and 36% were women. A total of 89 subjects (8.5%) had a positive ET. Positive exercise testing was associated with CE occurrence in a univariate analysis only in subjects with higher pre-test risk, defined by a 10-year Framingham risk >10.4% [hazards ratio (HR)=2.61; 95% confidence interval (CI) (1.07-6.40)]. In this risk category, ET was able to provide incremental information over the major risk factors in both men and women [risk factor-adjusted HR for positive ET=2.86; 95% CI (1.14-7.20)]. This risk excess in subjects with positive ET persisted even when a coronary revascularization was performed. Subjects with intermediate pre-test probability (10-15%) and positive ET had a post-test probability of CE largely equivalent to the probability in subjects with known CHD.
  
  
  CONCLUSIONS
  Additional information provided by ET in subjects with a pre-test risk at 10-years >10% should lead to a more efficient use of risk-reducing therapies than it would be the case in this risk category with the analysis of traditional risk factors only.
authors.affiliation: Département d'Epidémiologie, INSERM U558, CHU Toulouse, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Cournot
authors.forename: Dorota
authors.initials: D
authors.lastname: Taraszkiewicz
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.forename: Bernard
authors.initials: B
authors.lastname: Chamontin
authors.forename: Henri
authors.initials: H
authors.lastname: Boccalon
authors.forename: Helène
authors.initials: H
authors.lastname: Hanaire-Broutin
authors.forename: Jacques
authors.initials: J
authors.lastname: Puel
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis