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Coronary artery disease
ST elevation on the exercise ECG in patients presenting with chest pain and no prior history of myocardial infarction
  1. J C Murphy,
  2. P J Scott,
  3. H J Shannon,
  4. B Glover,
  5. J Dougan,
  6. S J Walsh,
  7. A A J Adgey
  1. The Heart Centre, Royal Victoria Hospital, Belfast, Northern Ireland
  1. Correspondence to Professor A A J Adgey, The Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland; jennifer.adgey{at}


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 to assess chest pain in patients without a prior history of MI. Those who developed STE were identified.

Results: STE occurred in 0.78% (116/14 941). 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 revascularisation (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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  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.