Yield of downstream tests after exercise treadmill testing: a prospective cohort study

Area of Science:

• Cardiology
• Diagnostic Testing
• Preventive Medicine

Background:

• The clinical utility of further diagnostic tests following an exercise treadmill test (ETT) is not well understood.
• Characterizing downstream testing patterns after ETT is crucial for optimizing patient care.

Purpose of the Study:

• To estimate the frequency of downstream diagnostic tests after exercise treadmill tests (ETTs).
• To evaluate the outcomes of patients undergoing further testing post-ETT.

Main Methods:

• A cohort of 3,656 individuals without known coronary artery disease undergoing clinical ETT were followed.
• Downstream noninvasive imaging and invasive angiography within 6 months were recorded.
• The combined endpoint included cardiovascular death, myocardial infarction, and coronary revascularization.

Main Results:

• 9.0% underwent noninvasive imaging and 2.3% had invasive angiography post-ETT.
• The annual incidence of the combined endpoint varied significantly based on ETT results (0.2% for negative, 1.3% for inconclusive, 12.4% for positive).
• Rapid electrocardiography (ECG) recovery predicted negative downstream tests, while typical angina with negative ECG predicted positive downstream tests.

Conclusions:

• The yield of additional testing after ETT is lowest in patients with rapid ECG recovery or negative ETT results.
• Patients with typical angina despite a negative ECG or a positive ETT have the highest yield for further investigation.
• These findings can help identify patients most likely to benefit from additional diagnostic testing post-ETT.