Clinical observation nearly as good as exercise testing in ischaemic heart disease.

A recent study, published in the British Medical Journal, suggests that a good history and physical examination has nearly the same prognostic value as exercise stress testing in patients with suspected angina.

Sekhri et al. recruited 176 consecutive patients with suspected angina and no previous diagnosis of coronary artery disease, all of whom had a resting ECG recorded. A total of 4 848 patients with a summary exercise ECG result recorded (positive, negative, equivocal for ischaemia) comprised the summary ECG subset of whom 1 422 with more detailed exercise ECG data recorded comprised the detailed ECG subset.

Their main outcome measures were death due to coronary heart disease or non-fatal acute coronary syndrome during nearly 2.5 years of follow-up.

There was no significant difference in outcome between patients who had received a clinical assessment alone and a clinical assessment followed by exercise stress testing. The authors concluded that in ambulatory patients with suspected angina, basic clinical assessment provided almost all the prognostic value of resting ECGs and nearly all the prognostic value of exercise ECGs. They recommend that some other form of assessment is needed to stratify risk in these patients.

Sekhri N, et al. BMJ 2008; 337: a2240.