THE VALUE OF EXERCISE ELECTROCARDIOGRAPHY TESTING IN THE IDENTIFICATION OF CORONARY RESTENOSIS - A PROBABILITY ANALYSIS

We studied by means of probability analysis the role of exercise ECG i n identifying coronary restenosis. A total of 213 patients were indepe ndently evaluated,by clinical history, conventional assessment of the exercise ECG ('yes or no' statement), D score (a discriminant;function derived from exercise EGG), and coronariography, 5.4 +/- 2.8 months a fter successful coronary angioplasty. The initial probability of reste nosis (30%), that is, the prevalence of the condition, was radically c hanged by the result of clinical history (77% for patients with angina vs. 17% for those without angina). By contrast, ECG binary assessment , due to its low accuracy (70% vs 82% of ciinical history, P < 0.005), was unable to significantly change the established probabilities afte r symptomatic evaluation. Finally, D score, which greatly enhanced spe cificity (92% vs. 76% of bivariate assessment, P < 0.0001), proved to be useful in changing the probability (from 32% to 76% or to 25%) of p atients (n = 34) with a discordant result (no angina/positive exercise EGG). When this stepwise approach was tested in 46 new patients, pred icted and observed probabilities were actually very similar. We conclu de that exercise ECG has a very limited role in identifying coronary r estenosis if positive responses are not adjusted with a weighted score which takes into account other exercise derived factors.