What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease (n=293). Intervention: Exercise stress testing vs. Coronary computed tomography angiography (CCTA). Primary outcome: Significant coronary artery disease.

What question did this study set out to answer?

This study aims to evaluate the effectiveness of exercise stress testing compared to coronary computed tomography angiography (CCTA) in detecting coronary artery disease among master athletes.

June 12, 2026Open Access

Assessing the safety of exercise stress testing alone to screen for coronary artery disease in master athletes updated findings from a contemporary cohort

Key Result

Exercise stress testing showed low diagnostic performance for significant CAD in master athletes, with a sensitivity of 20.8%, specificity of 75.3%, PPV of 7.8%, and NPV of 90.4%.

Key Points

This study aims to evaluate the effectiveness of exercise stress testing compared to coronary computed tomography angiography (CCTA) in detecting coronary artery disease among master athletes.
Registry included 293 master athletes from 2023 to 2025 in Brazil.
All underwent treadmill stress testing and CCTA due to abnormal tests or cardiovascular risk factors.
Primary risks included dyslipidaemia, diabetes, and hypertension.
199 athletes demonstrated normal exercise test results (67.9%) while 64 showed ischaemia (21.8%).
From normal exercise tests, 104 exhibited atherosclerosis, with 19 (18.3%) having significant stenosis.
The exercise stress test had a sensitivity of 20.8% and specificity of 75.3% for significant CAD.

Study Design

Type

Cohort (n=293)

Multicenter

Structured PICO

Does treadmill exercise stress testing accurately detect significant coronary artery disease compared to CCTA in master athletes?

Population

293 master athletes evaluated with treadmill stress testing and CCTA between 2023 and 2025.

Exposure

Treadmill exercise stress testing

Comparator

Coronary computed tomography angiography (CCTA)

Outcome

Diagnostic performance (sensitivity, specificity, PPV, NPV) for identifying significant coronary artery diseasesurrogate

Exercise stress testing alone has low diagnostic accuracy for detecting significant coronary artery disease in master athletes, highlighting the superior utility of anatomical evaluation with CCTA.

Abstract

Abstract Purpose Coronary artery disease (CAD) accounts for approximately 610000 deaths annually. In 2022, 315 million prevalent cases were recorded worldwide, and CAD remains the leading cause of sudden cardiac death in athletes over 35 years. Symptoms precede the event in only 12–36%. The exercise stress test is frequently used in athletes to detect ischaemic changes, yet among those with a positive test only 30% have stenosis 50%. Coronary computed tomography angiography (CCTA) offers sensitivity and specificity above 90% for detecting significant coronary stenoses. We present an updated clinical series of master athletes (2023–2025) assessing the correlation between treadmill stress test and CCTA in identifying CAD. Methods This registry included 293 master athletes followed in a sports cardiology department in Brazil between 2023 and 2025. All athletes underwent treadmill stress testing and CCTA, requested due to abnormal exercise testing, cardiovascular risk 10% according to the Framingham score, family history of CAD or atypical chest pain. The most common sports were marathon and mountain running (50%). The main risk factors were dyslipidaemia (68.6%), diabetes (10.2%) and hypertension (2%). Results All athletes completed the exercise stress test: 199 showed normal findings (67.9%) and 64 had a positive result for ischaemia (21.8%). On CCTA, 104 athletes with normal exercise testing (52.2%) exhibited coronary atherosclerosis, of which 19 (18.3%) had significant stenosis. Among those with abnormal exercise tests, 25 (39%) demonstrated atherosclerosis on CCTA, and 5 of these (20%) had significant stenosis. Overall diagnostic performance of the exercise stress test for significant CAD was low, with sensitivity 20.8%, specificity 75.3%, PPV 7.8% and NPV 90.4%. Conclusion This updated cohort reinforces the limited reliability of exercise stress testing as a single screening strategy for CAD in master athletes. Traditional risk factors and positive exercise testing show modest discriminatory value for identifying individuals with a higher atherosclerotic burden. The weak correlation between functional and anatomical testing is reflected by low likelihood ratios (LR+ 0.84; LR– 1.05), demonstrating that the exercise stress test does not meaningfully modify CAD probability. CCTA maintains its relevance due to its high diagnostic accuracy. Further studies are needed to clarify how the burden and distribution of atherosclerosis translate into cardiovascular risk in athletic populations. Understanding comorbidity profiles remains essential, and the Framingham score appears useful for CAD stratification in pre-participation evaluation.CCTA atherosclerosis according to TSTFor image description, please refer to the figure legend and surrounding text.