Clinical and angiographic correlates of exercise-induced ST-segment elevation. Increased detection with multiple ECG leads.

ST-segment elevation was observed in 47 of 720 patients who underwent treadmill exercise testing using 14 ECG leads 1 day before coronary arteriography. This abnormality was detected in lead V. in only 13 of 47 patients (28%) and in lead CM5 in only nine of 47 patients (19%). In 36 patients previous myocardial infarction (27 anterior, nine inferior) was diagnosed on the resting ECG; in all cases the ST-segment elevation during exercise occurred in leads with Q waves. In 34 of 36 patients (94%) a corresponding left ven- tricular wall motion abnormality was present, usually (33 of 36, 92%) a dyskinetic or akinetic segment. All but two of the 36 patients had a coronary stenosis > 70% in the artery perfusing the involved region.