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ST elevation on the exercise ECG in patients presenting with chest pain and no prior history of myocardial infarction.
  1. J Conleth Murphy (conleth_m{at}hotmail.com)
  1. The Heart Centre, Royal Victoria Hospital, Grosvenore Road, Belfast, Northern Ireland
    1. Peter J Scott (peterscott75{at}hotmail.com)
    1. The Heart Centre, Royal Victoria Hospital, Grosvenore Road, Belfast, Northern Ireland
      1. H Joanne Shannon (joshannon1{at}yahoo.com)
      1. The Heart Centre, Royal Victoria Hospital, Grosvenore Road, Belfast, Northern Ireland
        1. Benedict Glover (ben.glover{at}hotmail.com)
        1. The Heart Centre, Royal Victoria Hospital, Grosvenore Road, Belfast, Northern Ireland
          1. John Dougan (john.dougan{at}belfasttrust.hscni.net)
          1. The Heart Centre, Royal Victoria Hospital, Grosvenore Road, Belfast, Northern Ireland
            1. Simon J Walsh (simon.j.walsh{at}btinternet.com)
            1. The Heart Centre, Royal Victoria Hospital, Grosvenore Road, Belfast, Northern Ireland
              1. AA Jennifer Adgey (jennifer.adgey{at}belfasttrust.hscni.net)
              1. The Heart Centre, Royal Victoria Hospital, Grosvenore Road, Belfast, Northern Ireland

                Abstract

                Background/Objective: To assess the aetiology, and prognosis of ST segment elevation (STE) on the exercise electrocardiogram in patients with chest pain without a prior history of myocardial infarction (MI).

                Methods: Between January 1998 and December 2005, 14,941 exercise stress tests were performed in our department to assess chest pain in patients without prior history of myocardial infarction. Those who developed STE were identified.

                Results: STE occurred in 0.78% (116/14941). Coronary angiography was performed in 108 patients. All patients had at least one severe coronary artery stenosis (>70%). The site of STE on exercise ECG was shown to be 95.4% predictive of a severe stenosis in the coronary artery supplying that area. Lateral STE was rare (1/116). Ninety-eight patients underwent revascularisation; 67 patients had percutaneous coronary intervention (PCI) and 31 underwent coronary artery bypass grafting (CABG). Follow-up included recording of death, MI, cerebrovascular event, heart failure and target vessel revascularisation. The projected 7 year event-free survival probability was 62.1% for those undergoing CABG, 77.1% for those who had PCI and 68.6% for those not undergoing revascularization (no difference between these three groups (Log Rank p = 0.802)).

                Conclusions: STE on the exercise ECG is rare but specific for ischaemic heart disease and is predictive of a severe stenosis in the corresponding coronary artery. Prognosis is favourable following revascularisation.

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