Among patients with discordant exercise stress test findings (ECG+/TTE-), peak ST-segment depression >3 mm was significantly more common in those with obstructive CAD (17.6% vs 3.1%; p=0.01).
Cohort (n=115)
No
What are the predictors of obstructive coronary artery disease in patients with ECG-positive, TTE-negative exercise stress tests?
In patients with discordant exercise stress tests (ECG positive, TTE negative), peak ST-segment depression >3 mm is a predictor of obstructive coronary artery disease.
Absolute Event Rate: 17.6% vs 3.1%
p-value: p=0.01
AIM In exercise stress testing (EST), a discordant result with electrocardiogram (ECG)-positive and transthoracic echocardiogram (TTE)-negative is commonly encountered. This study aimed to determine the predictors of obstructive coronary artery disease (CAD) in patients with ECG positive, TTE negative ESTs. METHOD We performed a retrospective analysis of consecutive patients with discordant EST findings (ECG+ and TTE-) for ischaemia between November 2010 and June 2021. Key inclusion criteria were age >18 years and invasive or computed tomography coronary angiography within 12 months of EST. Patients with previous revascularisation were excluded. RESULTS Of 115 patients, 72% (n=83) were male and mean age was 62 years. Overall, 85% (n=98) of patients had no obstructive CAD while 15% (n=17) had obstructive CAD. Baseline characteristics of the two groups were well-matched. There were no between-group differences in the resting ECG with respect to rhythm, ST-segment depression (STD) or left ventricular hypertrophy by voltage criteria. Patients with obstructive CAD were more likely to have STD of >3 mm (17.6 vs 3.1%; p=0.01). There was no difference between the groups for the duration of STD into recovery or for the presence of early versus late resolution of STD. CONCLUSIONS Our findings suggest that among patients with discordant (ECG+/TTE-) EST findings, peak STD >3 mm may correlate with the presence of obstructive CAD on angiographic evaluation. There was no association between the duration of STD and the presence of obstructive CAD.
Dind et al. (2026) conducted a cohort in Discordant exercise stress test findings (ECG positive, TTE negative) (n=115). Obstructive CAD vs. No obstructive CAD was evaluated on Peak ST-segment depression >3 mm (p=0.01). Among patients with discordant exercise stress test findings (ECG+/TTE-), peak ST-segment depression >3 mm was significantly more common in those with obstructive CAD (17.6% vs 3.1%; p=0.01).