title: Stress-induced ST-segment elevation in patients without prior Q-wave myocardial infarction.
abstract: BACKGROUND
  Stress-induced ST-segment elevation is an uncommon finding that usually occurs in patients with prior myocardial infarction (MI). Our purpose was to assess the angiographic and clinical significance of this finding in patients without prior MI.
  
  
  METHODS
  Of the 29002 consecutive ambulatory patients who underwent stress myocardial perfusion imaging over a 5-year period, 205 (0.7%) developed stress-induced ST-segment elevation, of whom 39 (19%) had no Q-wave MI in leads showing ST-segment elevation during either exercise (n = 31) or dipyridamole (n = 8) stress myocardial perfusion imaging. All 39 patients were hospitalized and underwent coronary angiography.
  
  
  RESULTS
  Significant coronary artery disease was found in all 39 patients: 87% had critical (>or=90%) stenosis, and 59% had multiple vessel disease. During hospitalization, 37 patients (95%) underwent revascularization.
  
  
  CONCLUSIONS
  In patients without prior Q-wave MI, stress-induced ST-segment elevation is associated with critical coronary artery disease. Therefore, these patients should be considered for early coronary investigation.
authors.affiliation: Heart Institute, Chaim Sheba Medical Center, 52 621 Tel HaShomer, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beinart
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Michael
authors.initials: M
authors.lastname: Shechter
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.forename: Eli
authors.initials: E
authors.lastname: Rozen
authors.forename: Tal
authors.initials: T
authors.lastname: Beinart
authors.forename: Hanoch
authors.initials: H
authors.lastname: Hod
authors.forename: Pierre
authors.initials: P
authors.lastname: Chouraqui
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity