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Steven W. Lewis, MD, FCCP
IHC Health Plans, Inc Salt Lake City

JAMA. 1985;253(11):1558-1559.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The article by Laslett and Amsterdam,¹ "Management of the Asymptomatic Patient With an Abnormal Exercise ECG," is an extremely important one, because it so clearly demonstrates a common error in clinical decision making. Despite taking the reader through a clear and correct discussion of Bayes' theorem and then correctly applying this theorem to exercise testing of the asymptomatic patient, the authors reach the wrong conclusion.

They properly demonstrate the low predictive accuracy of the exercise tolerance test in the asymptomatic patient. They then, however, conclude that not only should the exercise tolerance test be done in the asymptomatic situation, but that in the event that the result is positive, an array of further testing is suggested.

The error is twofold. First of all, it is very difficult to improve on the asymptomatic state. This is particularly true as relates to coronary artery disease. True, in two . . . [Full Text PDF of this Article]

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