Clinical utility of the exercise ECG in patients with diabetes and chest pain

Objective: The purpose of this study was to determine the characteristics o f exercise treadmill testing in diabetic patients presenting with chest pai n. Background: The diagnosis of coronary artery disease (CAD) in diabetic pati ents is confounded by different manifestations of coronary disease than are seen in the general population. Because of the association of diabetes wit h accelerated CAD, it is critical to assess the diagnostic utility of the s tandard exercise test in diabetic patients with chest pain. Methods: This study was a retrospective analysis of standard exercise test results in 1,282 male patients without prior myocardial infarction who had undergone coronary angiography and were being evaluated for possible CAD at two Veterans' Administration institutions. Results: In patients with diabetes, 38% had an abnormal exercise test resul t, and the prevalence of angiographic CAD was 69%; the sensitivity of the e xercise test was 47% (95% confidence interval [CI], 41 to 58), and specific ity was 81% (95% CI, 68 to 89). In patients without diabetes, 38% had an ab normal exercise test result, and the prevalence of angiographic CAD was 58% ; the sensitivity of the exercise test was 52% (95% CI, 48 to 56), and spec ificity was 80% (95% CI, 76 to 83). The receiver operating characteristic c urves were also similar in both diabetic and nondiabetic patients (0.67 and 0.68, respectively). Conclusion: These data demonstrate that the standard exercise test has simi lar diagnostic characteristics in diabetic as in nondiabetic patients.