Management of the asymptomatic patient with an abnormal exercise ECG

The "positive" stress ECG in an asymptomatic individual should be interpreted cautiously, using both the details of the test results and details of the clinical history. The central concept that this test, in conjunction with the patient's clinical situation, does not yield an absolute answer regarding the presence of coronary artery disease, but rather a likelihood of the presence or absence of disease, forms the basis of this interpretation and the framework in which to make decisions regarding the advisability of further testing. In general, those asymptomatic individuals with a low posttest probability of disease should be followed clinically, those with an intermediate likelihood or strong personal concern should undergo further noninvasive testing, and only in those few with a high likelihood of disease after stress ECG testing should immediate coronary angiography be considered.