Indications, Criteria for Interpretation, and Utilization of Exercise Testing in Patients with Coronary Artery Disease

Abstract

A questionnaire was distributed to approximately 50 U.S. Veterans Administration hospitals, closely associated with academic medical centers in 1988–89 to ascertain indications, criteria for interpretation, and utilization of standard exercise electrocardiography results. Forty-four completed questionnaires were returned providing data on 41,212 exercise tests performed in the previous year. One millimeter (mm) of horizontal or downsloping ST depression was still the predominant criteria for classifying an exercise test as abnormal (in 93 % of the laboratories). Class I indications for exercise testing including (1) diagnosing coronary artery disease (CAD) in male patients suspected of having CAD (32 %); (2) identifying the high-risk patient with known CAD (26 %); (3) post-myocardial infarction risk stratification and profiling (18%), and (4) testing the post-coronary artery bypass surgery patient with recurrent symptoms (12%) accounted for 88% of the reported use. Exercise Thallium-201 scintigraphy was used four times more often than exercise radionuclide ventriculography. Sixty-eight percent of patients discharged after a diagnosed acute myocardial infarction underwent exercise testing. Exercise electrocardiography continued to have a major impact for the evaluation and prognostication of patients with coronary artery disease, and its use at the surveyed centers was in agreement with AHA/ACC guidelines.