| Author, Year (Reference) |
Sample |
Exclusion Criteria |
Mean Years of Followup |
Test |
Abnormal Test Result |
Cumulative Event Rate |
Adjusted Relative Risk (95% CI)
for CHD Events with Abnormal ST-Segment Response |
Sensitivity for CHD Events |
Positive Predictive Value of Abnormal
ST Response |
Variables for Which Relative Risk
Was Adjusted |
| Definition |
Prevalence |
| Giagnoni et al., 198336 |
514 factory workers in Italy
Age range: 18-65 y
73% men
|
Positive history and physical exam for CVD, resting blood
pressure ≥160/95 mm Hg, abnormal resting electocard-iogram |
6 y |
Submaximal supine cycle ergometry |
≥1 mm of horizontal/downsloping ST-segment depression
during or after exercise |
NR |
Normal exercise test 3.4%
Abnormal exercise test result 15.6%b |
5.5
(2.8-11.2) |
62 |
15 |
Age, systolic blood pressure, smoking, coronary risk index |
MRFIT Trial Research Group, 19858
Rautaharju et al., 198650
|
6,205 men in the upper 10% to 15% Framingham risk score
distribution
Age range: 35-57
100% men
|
Clinical heart disease, life-limiting conditions, diastolic
blood pressure ≥115 mm Hg, cholesterol ≥350 mg/dL |
7 y |
Submaximal |
Computer code ST- segment depression 16 muV-s or more in
leads CS5, aVL, aVF, V5 during or after exercise (in electrocard-iogram
with less than 6 muV-s depression at rest) |
12.2% |
Normal exercise test result 2/1,000 person yearsb
Abnormal exercise test result 7.6/1,000 person yearsb
|
3.5
(P <0.05)b
1.61
(P <0.01)c
|
NR |
36 |
Age, diastolic blood pressure, cholesterol, number of cigarettes
smoked daily |
Gordon et al., 198641
Ekelund et al., 198926
|
3,640 white men in Lipid Research Clinics
Prevalence Survey in United States and Canada
Mean age: 47
Age range: 35-59 y
100% men
|
Evidence of CHD by history, resting electrocardiogram,
and physician exam. Secondary hyperlipidem-ia, BMI >32.1 kg/m2,
blood pressure ≥165/105 mm Hg with antihypertensive or cardiovascular
medication; diabetes mellitus. |
8.1 y |
Submaximal modified Bruce |
≥1 mm of ST-segment depression or
elevation or computer- ST integral decreased or increased ≥10
muV-s from resting value |
8.3% |
Placebo group
Normal exerciser test result 13/1,000 person yearsb
Abnormal exercise test result 1.9/1,000 person yearsb
|
Placebo group
5.7
(2.7-12.2)b
3.3
(1.8-5.9)c
|
30 |
7.1 |
Age, LDL cholesterol level, HDL cholesterol
level, systolic blood pressure, smoking, family history |
Cholestyramine group
Normal exercise test result 7.2/1,000 person yearsb
Abnormal exercise test result 1.5/1,000 person yearsb
|
Cholestyramine group
4.9
(2.2-10.8)b
2.9
(1.6-5.2)c
|
| Fleg et al., 199019 |
407 residents of Baltimore, Maryland (mainly white)
Mean age ±SD 60 ±11 y
Range: 40-90 y
71% men
|
NR |
4.6 y |
Maximal treadmill with thallium modified Balke |
≥1 mm of horizontal/ downsloping ST-segment during
or after exercise |
Abnormal electro-cardiogram only 16.0%
Abnormal thallium scan only 14%
Both tests abnormal 6.0%
|
Both test results normal, 7%
Abnormal electrocardiogram only, 12%
Abnormal thallium scan, only 3%
Both tests abnormal, 48%
|
1.0
2.4
(P <0.05)
1.4
(NS)
3.6
(1.6-8.1)
|
40
N/A
28
|
24
N/A
48
|
Age, sex, hypertension, fasting blood glucose, total cholesterol,
BMI, smoking, exercise duration |
| Okin et al., 199140 |
3,168 participants in the Framingham Offspring Study
Mean age ±SD, 44 ±10 y Age range: 17-70 y
48% male
|
Medical contraindica-tions to exercise, history of myocardial
infarction, CHF, valvular disease, syncope, conduction abnormalities, digoxin
use, atrial fibrillation |
4.3 y |
Standard Bruce |
ST segment corrected for heart rate index >1.6 muV per
beat per min or abnormal rate recovery loop |
416/3168
13%
(either test abnormal)
|
Both tests normal 1.6%
Either test abnormal 4.1%
Both tests abnormal 9.8%
|
1.0
1.6
(1.1-2.5)
2.7
(1.8-4.0)
|
23%
8%
|
4%
10%
|
Age, sex, smoking, diastolic blood pressure, total cholesterol
level, fasting blood glucose, left ventricular hypertrophy on electrocardiography |
| Siscovick et al., 199112 |
3,617 white men in the Lipid Research Clinics Prevalence
Survey
Mean age: NR
Age range: 35-59 y
100% male
|
Clinical evidence of CHD or CHF on history, various resting
electrocard-iogram abnormalities |
7.4 y |
Submaximal modified Bruce |
Visual code ≥1 mm ST-segment depression or elevation
or computer code ≥10 muV 1/N s |
6.6% |
Overall 2%d |
2.6 (1.3 - 5.2)d |
18% |
5% |
Age, LDL cholesterol level, HDL cholesterol level, smoking,
physical activity, workload achieved, family history of CHD, BMI, alcohol
consumption |
| Blumenthal et al., 199632 |
264 healthy siblings of individuals with
CAD before age 60 in Baltimore, Maryland
Mean age ±SD, 46 ± 8
Age range: 37-59 y
69% men
|
Known CAD, corti-costeriods, collagen vascular
disease, decreased life expectancy, functional status limitations |
6.2 y |
Modified Bruce and thallium scintigraphy |
≥1 mm (≥2 mm for women)
of horizontal or downsloping depression in 3 consecutive beats during exercise
or first 3 min of recovery |
Abnormal exercise electrocard-iogram 5.4%
Abnormal plus thallium scan 18.1%
Abnormal exercise electrocard-iogram and scan 4.6% |
Normal 3% |
1.0 |
|
|
Age, sex |
| Abnormal exercise electrocardiogram 7% |
1.5 (0.2-12.5) |
N/A |
N/A |
| Abnormal thallium scan 13% |
3.6 (1.1-11.4) |
63% |
20% |
| Abnormal exercise electrocard-iogram and scan 50% |
14.5
(4.2-50.2) |
32% |
50% |
| Okin et al., 199639 |
5,940 men in the usual care group of MRFIT
Mean age: NR
Age range: 35-57 y
100% men
|
No evidence of CHD by history, physical examination, or
resting electrocard-iography |
7 y |
Submaximal treadmill |
ST segment corrected for heart rate index >1.6 muV per
beats per min |
729/5,940
(12.3%) |
Normal exercise test result 1.3%b
Abnormal exercise test result 5.4%b
|
3.6
(2.4-5.4)b
|
36% |
5% |
Age. Diastolic blood pressure, cholesterol level, smoking |
| Katzel et al., 199929 |
170 healthy sedentary obese men living in the Baltimore-Washington,
DC area (96% white)
Mean age: NR
Age range: 45-79 y
100% men
|
History or laboratory evidence of CAD, diabetes mellitus,
hypertension, hyperlipidemia |
7.3 y |
Maximal Bruce |
≥1 mm of horizontal or downsloping ST-segment
depression in 2 or more leads |
37/170
(22%) |
Overall 18% |
4.23
(2.03-8.83) |
55% |
46% |
Age, BMI, maximal VO2, fasting glucose level |
| Gibbons et al., 200033 |
25,927 patients of a preventive medicine
clinic in Texas (mainly white)
Mean age: 42.9
Age range 20-82 y
100% men
|
Evident CHD, severe aortic stenosis, acute systemic
illness, uncontrolled atrial or ventricular arrhythmias, pericarditis,
myocarditis, thrombophlebitis or exercise- limiting orthopedic problems |
8.4 y |
Maximal treadmill modified Blake |
Chest pain and ≥1mm ST-segment depression
or elevation, exercise induced-decrease ≥10 mm in systolic blood
pressure, systolic blood pressure >250 mm Hg, diastolic blood pressure >120
mm Hg, ventricular tachycar-dia, left bundle-branch block, right bundle
branch block, super-ventricular tachycardia |
No risk factors, 3.0% |
No risk factors
Normal exercise test result 0.08/1000 person yearsb
Abnormal ETT 2.8/1000 person yearsb
|
21
(6.9-63.3)b
|
60 |
2.2 |
Age |
>1 risk factor,
7.1% |
>1 risk factor
Normal ETT 0.5/1000 person yearsb
Abnormal exercise test result 7.6/1000 person yearsb
|
9b |
61 |
7.7 |
|
Josephson et al., 199011
Rywik et al., 200221
|
1,083 participants in the Baltimore Longitudinal
Study of Aging
Mean age ±SD, 52 ±18 y
57% men
|
History of angina or heart failure, Q wave on
resting electrocardio-graphy, valvular disease, use of anti-arrhythmic
drugs, inability to achieve 85% of maximal heart rate |
7.9 |
Modified Balke |
Normal |
Men 4%
Women 3% |
1.0e |
Men 74
Women 68 |
Men 16
Women 7 |
Age, cholesterol, sex, exercise duration |
| Minnesota Code 11.1e |
20% |
Men 17%
Women 8% |
2.7
(1.6-4.7)f |
| Minnesota Code 11.5e |
5.5% |
Men 17%
Women 11% |
2.7
(1.05-7.10)f |
| Minnesota Code 11.2e |
7% |
Men 10%
Women 5% |
OR 1.8f
(0.6-5.4) |
| Minnesota Code 11.4e |
11.5% |
Men 17%
Women 3% |
OR 1.3f
(0.6-2.9) |
| Jouven and Ducimetiere, 200045 |
6,101 Frenchmen in Paris Civil Service
Age range: 42-53 y
100% men
|
Known or suspected CVD, resting systolic blood pressure ±180
mm Hg, resting Electrocard-iographic abnormality |
23 |
Bicycle ergometry |
J-point depression of at least 1 mm with a flat or downsloping
ST segment during exercise or recovery |
4.4% |
Normal exercise test result, 6.4%
Abnormal exercise test result 16.7%b
|
2.6
(1.93-3.59)b |
10 |
17-25 |
Age, BMI, heart rate at rest, smoking, physical activity,
diabetes mellitus, total cholesterol level, premature ventricular complex |
| Laukkanen et al., 200120 |
1,769 participants, population in Kupio Ischemic Heart Disease
Study base sample of Finnish men
Mean age ±SD,
52 ±5.2 y
100% men
|
Known CHD or symptoms suggestive of CHD |
10 |
Maximal Bicycle ergometry |
>1 mm ST-segment depression during exercise |
10.7% |
Normal exercise test result 9.2%
2.4%b
Abnormal 15.3%
7.9%b
|
1.7
(1.1-2.6)
3.5
(1.9-6.5)b
|
16 |
15 |
Age, examination year, smoking, systolic blood pressure,
alcohol consumption, BMI, max oxygen uptake, diabetes mellitus, LDL cholesterol
level, HDL cholesterol level |
| Rutter et al., 200213 |
86 diabetic patients in the United Kingdom
Mean age ±SD,
62 ±7 y
Age range: 46-74 y
72% men
|
History of CAD |
2.8 |
Treadmill |
>1 mm of horizontal or downsloping ST-segment depression
for 3 consecutive beats |
52% |
Both normal and abnormal exercise test results
17% |
21
(2-204) |
100% |
20% |
Ankle brachial index, microalbuminuria, Framingham 10-y
CHD risk >30%, fibrinogen level |
| Mora et al., 200342 |
2994 women enrolled in the Lipid Research Clinics Prevalence
Study
Age range 30-80
0% men
|
Pregnancy or significant cardiovascu-lar disease |
20.3 |
Maximal Bruce |
≥1mm horizontal or downsloping ST-segment depression
at 0.08 seconds after the J point during recovery or exercise |
4.7% |
Both normal and abnormal exercise tolerance test results
5%b
14%c
|
0.88
(0.48-1.61)b
0.69
(0.45-1.04)c
|
|
|
Age, smoking, diabetes, family history of premature heart
disease, obesity, HDL cholesterol level, LDL cholesterol level, triglyceride
level, hypertension |