Farewell to exercise ECG's?
A total of 471 Dutch patients seen in a fast track chest pain clinic, were randomised to CT angiography (CTA) or exercise ECG. The latter is cheap but not very sensitive and often means further tests are necessary. Diagnostic accuracy is only 70%, and very fat and very unfit patients can't always manage it. The downside of CTA is that the contrast medium can cause kidney damage, it involves radiation, and arrhythmias can complicate the results. Presumably it's also more expensive. On the plus side, almost everyone can undergo CTA, the results are more sensitive though less specific than exercise ECG, and if your CTA is negative you can be almost certain that your coronary arteries are OK. A good guess is that exercise ECG is on its way out.
Source: 5 Minutes of International Medicine from BMJ Group
Reference: Heart 2009;95:1669-1675