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March 31, 2026Heart Lung and Circulation

Predictors of Obstructive Coronary Artery Disease in Positive Electrocardiogram, Negative Echocardiogram Stress Tests: A Single-Centre Retrospective Analysis

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Why the study?

Discordant exercise stress test results with positive electrocardiogram and negative echocardiogram findings are commonly encountered, but predictors of obstructive coronary artery disease in this population remain unclear.

What are the predictors of obstructive coronary artery disease in patients with ECG-positive, TTE-negative exercise stress tests?

Population

115 patients with discordant EST findings (ECG+ and TTE-) undergoing coronary angiography within 12 months

Comparison

Obstructive CAD vs no obstructive CAD

Design

Single-centre retrospective analysis

Key result

Among patients with discordant exercise stress test findings (ECG+/TTE-), peak ST-segment depression >3 mm was significantly more common in those with obstructive CAD (17.6% vs 3.1%; p=0.01).

Authors

ADAndrew DindDMDaniel McGhieDMDaniel McIntyre

Discussion

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Overview

Peak ST depression >3 mm may flag higher CAD risk in discordant tests; hypothesis-generating and requires prospective validation.

Key Points

  • This study aims to identify predictors of obstructive coronary artery disease in patients with discordant exercise stress test results.
  • Conducted a retrospective analysis of patients with discordant EST findings (ECG+ and TTE-) from November 2010 to June 2021.
  • Included only patients over 18 years with invasive or CT coronary angiography within 12 months.
  • Excluded patients with prior revascularization.
  • Of 115 patients, 15% (n=17) had obstructive CAD and 85% (n=98) had no obstructive CAD.
  • Higher rates of ST-segment depression (>3 mm) were seen in patients with obstructive CAD (17.6% vs 3.1%, p=0.01).
  • No significant differences were found in other ECG characteristics or in the duration of ST-segment depression.

Study Design

Type

Cohort (n=115)

Multicenter

No

Structured PICO

What are the predictors of obstructive coronary artery disease in patients with ECG-positive, TTE-negative exercise stress tests?

P
Population
115 adults (age >18 years) with discordant exercise stress test findings (ECG positive, TTE negative for ischaemia) who underwent invasive or computed tomography coronary angiography within 12 months. Excluded: previous revascularisation. Mean age 62 years, 72% male.
O
Outcome
Presence of obstructive coronary artery disease on angiographic evaluationsurrogate

Main Result

Absolute Event Rate: 17.6% vs 3.1%

p-value: p=0.01

In patients with discordant exercise stress tests (ECG positive, TTE negative), peak ST-segment depression >3 mm is a predictor of obstructive coronary artery disease.

Limitations

  • Single-centre
  • Retrospective analysis

Cite This Study

Dind et al. (2026) conducted a cohort in Discordant exercise stress test findings (ECG positive, TTE negative) (n=115). Obstructive CAD vs. No obstructive CAD was evaluated on Peak ST-segment depression >3 mm (p=0.01). Among patients with discordant exercise stress test findings (ECG+/TTE-), peak ST-segment depression >3 mm was significantly more common in those with obstructive CAD (17.6% vs 3.1%; p=0.01).

synapsesocial.com/papers/6a025cbeedf6f4813859493ehttps://doi.org/10.1016/j.hlc.2025.11.007
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