ST elevation on the exercise ECG in patients presenting with chest pain and no prior history of myocardial infarction.
OBJECTIVE
To assess the aetiology, and prognosis of ST-segment elevation (STE) on the exercise electrocardiogram in patients with chest pain without a prior history of myocardial infarction (MI).


METHODS
Between January 1998 and December 2005, 14 941 exercise stress tests were performed to assess chest pain in patients without a prior history of MI. Those who developed STE were identified.


RESULTS
STE occurred in 0.78% (116/14 941). Coronary angiography was performed in 108 patients. All patients had at least one severe coronary artery stenosis (>70%). The site of STE on exercise ECG was shown to be 95.4% predictive of a severe stenosis in the coronary artery supplying that area. Lateral STE was rare (1/116). Ninety-eight patients underwent revascularisation; 67 patients had percutaneous coronary intervention (PCI) and 31 underwent coronary artery bypass grafting (CABG). Follow-up included recording of death, MI, cerebrovascular event, heart failure and target vessel revascularisation. The projected 7-year event-free survival probability was 62.1% for those undergoing CABG, 77.1% for those who had PCI and 68.6% for those not undergoing revascularisation (no difference between these three groups, log rank p = 0.802).


CONCLUSIONS
STE on the exercise ECG is rare but specific for ischaemic heart disease and is predictive of a severe stenosis in the corresponding coronary artery. Prognosis is favourable following revascularisation.
Murphy
J C
JC
The Heart Centre, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland.
Scott
P J
PJ
Shannon
H J
HJ
Glover
B
B
Dougan
J
J
Walsh
S J
SJ
Adgey
A A J
AA
D002637:Chest Pain / Q000209:etiology*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009204:Myocardial Revascularization / Q000379:methods