The importance of assessing time‐course behaviour of abnormal ST/T changes after exercise

Routine stress electrocardiography has been criticised for yielding too many so-called 'false-positive' results because ST/T changes that develop during and after exercise are prevalent. Recent studies in our institution indicate, however, that the time-course behaviour patterns of these ST/T configurational 'abnormalities' after exercise are different from those reflecting myocardial ischaemia due to epicardial coronary artery disease (CAD). Time-course analysis increases the predictive value of exercise testing and has dramatically decreased the number of asymptomatic subjects or symptomatic patients at low risk of having CAD being subjected to coronary arteriography in our institution. Our method of assessing post-exercise time course patterns of abnormal ST/T are described in detail. Ischaemic ST/T abnormalities have late onset, early offset or early onset, late offset whereas those ST/T changes associated with normal epicardial coronary arteries have late onset, late offset or early onset, early offset post-exercise time course patterns.