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To the Editor: In the study by Dr Aktas and colleagues,¹ patients in the third tertile of European SCORE were more likely to be older men with a more adverse risk profile. Seven percent of participants in the third European SCORE tertile had ischemic ST-segment changes between 1 mm and less than 2 mm and 5% had ischemic ST-segment changes of 2 mm or higher; 21% had abnormal heart rate recovery, 4% had frequent ventricular ectopy, and 42% had impaired functional capacity for age and/or sex. Any information about subsequent management differences for participants in this group compared with the participants in the first and second tertile would be valuable. Within 3 months of their stress test, a total of 190 patients (5%) underwent either nuclear or echocardiographic stress imaging and 21 patients (0.6%) had coronary angiography. It would be helpful to know which patients underwent these procedures.

Sujeeth R. Punnam, MD
sujeethpunnam@hotmail.com
Nacogdoches Heart Clinic
Nacogdoches, Tex

1. Aktas MK, Ozduran V, Pothier CE, Lang R, Lauer MS. Global risk scores and exercise testing for predicting all-cause mortality in a preventive medicine program. JAMA. 2004;292:1462-1468. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293:159.

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