Eight-year follow-up of exercise electrocardiograms in healthy, middle-aged aviators

To study to prognostic capabilities of the exercise electrocardiogram (ECG) in a fit, healthy, middle-aged population, 548 members of the U.S. Navy's "1000 Aviator" cohort were exercised to 85% predicted maximum heart rate in 1969 and then followed-up in 1977 for the development of clinically evident coronary artery disease (CAD). Of these subjects, 23 (4.2%) had significant ST depression during their exercise test in 1969. At the end of the 8-year follow-up period, 38 of the 548 subjects (6.9%) had developed clinically evident CAD. The sensitivity (percent of disease predicted by an abnormal test) and predictive value (percent of abnormal tests predictive of disease) of an abnormal exercise test were 15.7% and 26%, respectively. We conclude that even in a carefully screened aviator population with a low risk for CAD, a single normal exercise ECG does not exclude the presence of latent CAD. Furthermore, in this population, a single abnormal exercise ECG should not be a disqualifying defect without further work-up.