Document Detail

ST elevation on the exercise ECG in patients presenting with chest pain and no prior history of myocardial infarction.
MedLine Citation:
PMID:  19570758     Owner:  NLM     Status:  MEDLINE    
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.
J C Murphy; P J Scott; H J Shannon; B Glover; J Dougan; S J Walsh; A A J Adgey
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Publication Detail:
Type:  Journal Article     Date:  2009-06-30
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  95     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-15     Completed Date:  2009-12-17     Revised Date:  2010-06-14    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1792-7     Citation Subset:  AIM; IM    
The Heart Centre, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland.
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MeSH Terms
Chest Pain / etiology*
Coronary Angiography
Coronary Stenosis / diagnosis
Electrocardiography / methods*
Exercise Test / methods*
Follow-Up Studies
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Revascularization / methods
Comment In:
Heart. 2010 Jun;96(12):995; author reply 995-6   [PMID:  20538679 ]

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