The exercise treadmill test: predictors of true presence of significant coronary stenosis in patients with severe ST-segment depression

Abstract

Objective Significant coronary stenosis is not always present in patients with even severe (≥ 2.0 mm) ST-segment depression in the exercise treadmill test (ETT). The purpose of this study was to determine the clinical and ETT-related predictors of true presence of significant coronary stenosis in this population.Methods A total of 212 consecutive patients who showed severe ST-segment depression in ETT and underwent coronary angiography were included in this study. Clinical characteristics and ETT parameters were compared according to presence or absence of significant coronary stenosis. Logistic regression analysis was performed to identify the independent predictors of significant coronary stenosis.Results Significant coronary stenosis was present in 105 (49.5%) patients. Multivariable regression analysis showed that ST-segment depression persisting into recovery (odds ratio: 11.1, 95% confidence interval: 2.4–51.7, P= 0.002), ST-segment depression occurring at stage II (odds ratio: 10.3, 95% confidence interval: 2.0–54.1, P= 0.006), ST-segment depression combined at I, aVL, or V2-3 (odds ratio: 10.5, 95% confidence interval: 1.3–81.8, P= 0.025), hypertension (odds ratio: 4.2, 95% confidence interval: 1.3–13.5, P= 0.007), and typical chest pain (odds ratio: 4.1, 95% confidence interval: 1.2–14.6, P= 0.023) were the predictors of the presence of significant coronary stenosis.Conclusions The present study showed that the independent predictors of true presence of significant coronary stenosis in patients with severe (≥ 2.0 mm) ST-segment depression in ETT are ST-segment depression which begins at stage II or persists into recovery or occurs in I, aVL, or V2-3, hypertension, and typical chest pain.