PT  - JOURNAL ARTICLE
AU  - Murphy, J C
AU  - Scott, P J
AU  - Shannon, H J
AU  - Glover, B
AU  - Dougan, J
AU  - Walsh, S J
AU  - Adgey, A A J
TI  - ST elevation on the exercise ECG in patients presenting with chest pain and no prior history of myocardial infarction
AID  - 10.1136/hrt.2008.163691
DP  - 2009 Nov 01
TA  - Heart
PG  - 1792--1797
VI  - 95
IP  - 21
4099  - http://heart.bmj.com/content/95/21/1792.short
4100  - http://heart.bmj.com/content/95/21/1792.full
SO  - Heart2009 Nov 01; 95
AB  - 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.