The limited prognostic power of exercise ECG in microvascular disease
A single-centre observational study of 760 chest pain patients with suspected coronary microvascular dysfunction (CMD) found that abnormal ST-segment changes on exercise electrocardiography (ex-ECG) had limited prognostic value. While initial Kaplan-Meier analysis showed a significant separation in major adverse cardiac events (MACE) between patients with abnormal and normal ex-ECG, this association disappeared after adjusting for age, sex, comorbidities, and exercise capacity. The positive predictive value of an abnormal ex-ECG for MACE was only 25%, dropping to 17% when patients with known coronary artery disease were excluded. The study concludes that in patients with suspected CMD, ischaemic ECG changes show poor sensitivity and low predictive value for future cardiac events, though reduced exercise capacity itself remained an independent risk factor.
Why it might matter to you:
This research directly challenges the routine reliance on exercise ECG for risk stratification in a specific, diagnostically challenging patient population. For clinicians, it underscores the importance of a nuanced, multifactorial assessment that prioritizes functional capacity over isolated ECG findings when managing chest pain where microvascular dysfunction is suspected. It provides evidence that could refine clinical decision-making and prevent potentially unnecessary interventions based on a test with limited prognostic utility in this context.
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