Stress Testing in the Prognosis and Management of Ischemic Heart Disease

Stress testing is by no means perfect as far diagnosing coronary artery disease, but at this time it is the single best noninvasive method for establishing the presence of ischemic heart disease. From the data shown here, one can see that it adds some important prognostic features as well. The American Heart Association has published a "Coronary Risk Handbook" which can be used to predict the likelihood of a future coronary event by means of accepted risk factors such as hypertension, cholesterol level, and smoking. If we include a positive stress test as a risk factor and compare it to the others, it is clear that a positive stress test has a much higher correlation with future coronary events than any of the other risk factors alone or in combination (Figure 12). Physicians should pay close attention to all of the mentioned factors while carrying out a stress test rather than just looking for ST depression alone. The occurrence of anginal pain, the time of onset, the degree of ST depression, and the patient's pulse and blood pressure response are all useful in assessing the degree of coronary involvement and in predicting an individual's chances of suffering some form of coronary event.