Management of the asymptomatic patient with an abnormal exercise ECG
L. J. Laslett and E. A. Amsterdam
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.
