Key result
Significant CAD affects ~40% of patients with chest pain despite a negative exercise test.
Why the study?
The significance of a negative exercise test in patients with chest pain regarding the presence of coronary artery disease was unclear.
Does a negative exercise test predict the absence of severe coronary artery disease on coronary arteriography in patients with chest pain?
Observational (n=53)
Does a negative exercise test predict the absence of severe coronary artery disease on coronary arteriography in patients with chest pain?
A negative exercise test at >85% predicted maximal heart rate makes three-vessel or left main coronary artery disease highly unlikely, particularly in women with atypical chest pain.
Answers are grounded in this paper and cite their sources.
Negative exercise tests warrant caution in chest pain evaluation; leaves open optimal testing strategies pending prospective data.
Fifty-three patients with chest pain and a negative exercise test at greater than 85% predicted maximal heart rate underwent coronary arteriography. Twenty-one patients (40%) had significant luminal narrowing in one or two vessels. No patient had left main disease. Pathologic electrocardiographic Q waves were present in only coronary heart disease patients (p less than 0.001). There was no difference (p greater than 0.05) in prevalence of T wave abnormalities, chest pain or ventricular beats during exercise in patients with or without coronary disease. Analysis of sex distribution revealed that typical angina pectoris was uncommon in the women (p less than 0.001) and all twenty-one coronary patients were men (p less than 0.001). We conclude that in patients with chest pain and a negative exercise test, three vessel or left main coronary artery disease is unlikely. Also, women with atypical chest pain and a negative exercise test are unlikely to have a fixed coronary obstruction.
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Weisburst et al. (1979) conducted an observational in Chest pain with a negative exercise test (n=53). Negative exercise test was evaluated on Significant luminal narrowing in one or two vessels. Among 53 patients with chest pain and a negative exercise test, 40% had significant 1- or 2-vessel coronary disease, but none had left main disease, and all affected patients were men.
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