The Significance of Equivocal Exercise Treadmill ECG for Intermediate Risk Chest Pain Assessment - Insight From...

Area of Science:

• Cardiology
• Diagnostic Imaging
• Internal Medicine

Background:

• Exercise treadmill testing (ETT) is a primary diagnostic tool for troponin-negative chest pain.
• Inconclusive ETT results frequently necessitate repeat testing.
• Coronary computed tomographic angiography (CCTA) offers high negative predictive value for coronary artery disease (CAD).

Purpose of the Study:

• To evaluate the diagnostic utility of ETT and CCTA in patients with intermediate risk of CAD and inconclusive ETT findings.
• To analyze the correlation between ETT results, CCTA findings, and subsequent clinical outcomes.

Main Methods:

• Retrospective analysis of 346 patients who underwent both ETT and CCTA.
• Blind review of ETTs, defining equivocal results as indeterminate per ACC/AHA guidelines.
• Collection of baseline demographics, clinical data, and follow-up outcomes including major adverse cardiac events (MACE).

Main Results:

• Obstructive CAD was identified in 25% of patients overall.
• Patients with equivocal ETTs showed a 20% prevalence of obstructive CAD.
• Obstructive CAD prevalence was 8% in negative ETTs and 29% in positive ETTs, with lower rates in females.

Conclusions:

• Equivocal ETT results warrant further investigation as they can indicate obstructive CAD.
• Positive ETT results do not always necessitate invasive angiography, suggesting a role for CCTA.
• CCTA serves as a crucial gatekeeper test for patients with low-to-intermediate pre-test probability of obstructive CAD.