| Author, Year (Reference) | Sample | Exclusion Criteria | Test | Definition of Abnormal Exercise Electrocardiography Result | Prevalence of Abnormal Exercise Tolerance Test Result | Definition of Abnormal Cardiac Catheterization Result | Abnormal Catheterizations/Total Catheterizationsb | Abnormal Catheterizations/ Abnormal Exercise Tolerance Test Resultb | Abnormal Exercise Tolerance Test Result and Abnormal Catheterizations/ All Screened Personsb | Quality Grade |
|---|---|---|---|---|---|---|---|---|---|---|
| Caralis et al., 197927 | 3,496 men and women Mean age: NR % men NR |
NR | Maximal exercise and thallium scintigraphy | >2 mm of horizontal ST-segment depression | 22/3496 (0.6%) |
NR | 10/15 (66.7%) |
10/22 (45.5%) |
10/3,496 (0.3%) |
Fair |
| Piepgrass et al., 198216 | 771 men in U.S. Air Force flight crew Mean age ±SD, 42 ±5.2 y |
Resting electrocardio-graphic abnormalities, history of chest pain, cardiovascular disease, marked hypertension | Maximal treadmill or two-step double Master's | >0.1 mV of ST-segment depression 80 ms from the J point or exercise induced arrhythmia | 27/771 (3.5%) |
NR | 4/19 (21%) |
4/27 (14.8%) |
4/771 (0.5%) all cases were mild to moderate disease |
Fair |
| Hollenberg et al., 198538 | 377 U.S. Army officers Mean age 37y % men NR |
Known CHD | Maximal treadmill - U.S. Air Force School Aerospace Medicine Protocol | >1 mm ST depression during or after exercise or treadmill exercise score < 5 units | 45/377 (12%) |
>50% narrowing of the luminal diameter of major epicardial artery | 1/10 (10%) |
1/45 (2%) |
1/377 (0.3%) 1 had 1- vessel disease |
Fair |
| Boyle et al., 198714 | 1,174 employees from 2 factories in the United Kingdom Mean age: NR 95% men |
Symptoms of angina, orthopedic problems, hypertension with retinopathy, fainting, fibrillation | Treadmill | Maximal ST/heart rate slope value of >13 mm·beats-1 min 10-3 |
68/1,174 (5.8%) |
>75% stenosis of epicardial artery | 9/24 (37.5%) |
9/68 (13.2%) |
9/1,174 1 patient had coronary artery bypass graft surgery |
Fair |
| Okin et al.,198831 | 606 men in the Army Reserve at moderate to high risk by Framingham Risk score Mean age: NR 100% male |
Known or suspected CHD or angina | Modified Balke-Ware with radionuclide scintigram for an abnormal exercise ECG | >1 mm ST depression | 10/606 (1.7) positive—abnormal exercise electro-cardiogram and scintigram; 52/606 (8.6) inconclusive—abnormal exercise electrocard-iogram and normal scintigram) |
>50% narrowing of the luminal diameter | 7/10 (70%) |
7/10 (70%) |
7/606 2 patients had 3-vessel disease, |
Good |
| Koistinen 199015;75 | 136 diabetic patients in Finland Mean age: 49 y 62% men |
Clinical evidence of CHD, use of lipid lowering agents, diabetes mellitus for less than 5 y, retinopathy, renal failure | Maximal bicycle ergometry and thallium scintigraphy | >1 mm horizontal or downsloping ST-segment depression | 40/136 (29%) |
Significant (>50%) narrowing of the luminal diameter | 12/34 (35%) |
12/40 (30%) |
12/136 2 patients had 3-vessel disease, 5-had 2-vessel disease, 5 had 1-vessel disease |
Fair |
| Dunn et al., 199130 | 1,930 patients referred to Cleveland Clinic Foundation for screening exercise tolerance testing in 1987-1988(5.6% had history of chest pain) Mean age: 49 y 85% men |
Known CAD | Symptom-limited exercise electrocardiography, then thallium scintography if results were abnormal | >1 mm of horizontal or downsloping ST-segment depression, or arrhythmia | 155/1,930 (8%) |
>50% blockage of any major vessel | 25/41 (61%) |
25/155 (16.1%) |
25/1,930 6 patients had coronary artery bypass graft surgery |
Fair |
| Massie et al., 199318 | 226 men from the San Francisco Veteran's Medical Center, all of whom had hypertension and at least 1 other cardiovascular risk factor Mean age ± SD, 61 ± 8 y 100% men |
Known cardiac disease history or symptoms, resting electrocardio-graphy abnormalities, paced rhythm, noncardiac limitation to exercise | Standard Bruce with thallium scintigraphy | >0.1 mV of additional horizontal or downsloping ST-segment depression at 80 ms after the J point | Abnormal exercise electrocard-iogram 67/226 (30%) Abnormal scintigram 41/226 (18%) |
Intraluminal lesion of =50% diameter of vessel in 2 projections | 14/26
18/21 |
14/67
18/29 |
20/226 6 patients had left main disease or 3-vessel disease; 5 had 2-vessel disease; 7 had 1-vessel disease |
Fair |
| Davies et al., 199623 | 5,000 men from the United Kingdom Mean age: NR 100% men |
NR | Modified Balke | 1 mV of horizontal or downsloping depression persisting for >5 complexes | 162/5,000 (3.2%) |
>75% stenosis epicardial artery | 67/86 (78%) |
67/162 (41.4%) |
67/5,000 26 patients had coronary artery bypass graft surgery |
Fair |
| Cameron et al., 199725 | 229 Australians who responded to questionnaire about chest pain Mean age: NR 43% men |
Known CAD or negative screening questionnaire | Modified Bruce | Flat ST- segment depression >0.15 mV | Men |
NR | 10/13 (77%) |
10/32 (31%) |
10/229 4 patients had coronary artery bypass graft surgery |
Fair |
| Pilote et al., 199828 | 4,334 patients referred to Cleveland Clinic Foundation for screening exercise tolerance testing in 1990-1993 Median age: 51 y 89% men |
History of chest pain, heart failure, valvular or congenital heart disease, arrhythmia or digitalis use | Bruce or modified Bruce | >1 mm horizontal or downsloping ST-segment depression, >1 mm ST elevation in leads other than aVR or V1, decrease in blood pressure >10 mmHg, typical chest pain, failure to reach target heart rate | 633/4,334 (15%) |
Coronary artery disease >1 coronary segment with >50% stenosis | 71/126 (56%) |
71/633 (11%) |
71/4,334 19 patients had left main disease or 3-vessel disease |
Fair |
| Livschitz et al., 200022 | 4,900 male soldiers in the Israeli army >39 years of age Mean age ±SD 43 + -3 y 100% men |
Angina, heart failure, valvular disease, congenital heart disease, arrhythmia | Bruce | >1 mV of horizontal or downsloping ST-segment depression or >1.5 mV upsloping ST-segment depression | 299/4,900 (6.1%) |
NR | 3/4 (75%) |
3/299 (1%) |
3/4900 1 patient had coronary artery bypass graft surgery 2 had 1-vessel disease |
Good |
| Blumenthal et al., 200317 | 734 primarily white healthy siblings of persons with CAD diagnosed before age 60 in Baltimore Mean age: NR "Primarily male" |
Known CAD, limitations that precluded testing | Modified Bruce and thallium scintigraphy | NR for exercise tolerance testing | 153/734 (Abnormal exercise electrocardio-gram, scan, or both) |
Clinically significant CAD: intraluminal lesion of >50% diameter | 41/105 (39%) |
41/153 (27%) |
41/734 (5.5%) |
Good |
a CAD = coronary artery disease; CHD = coronary heart disease; NR = not reported
b Percentages were calculated by the authors of this report.