The Exercise Test and Prognosis of Coronary Heart Disease

Abstract

One hundred and fifty -three railway employees with known or suspected coronary artery disease were examined with an ecg exercise test and followed for at least 5 years. Thirty-seven tests were positive and 116 were negative. The incidence of myocardial infarction was approximately 3 times greater in those with a typical ischemic response and the death rate was almost double. Twenty-one men with a postive response escaped a myocardial infarction. Eleven men thought to have classical angina had a negative response to exercise, within 6 years 10 had a myocardial infarction or developed incapacitating angina. The ischemic response to an exercise test indicates transient coronary artery insufficiency and has prognostic implications of statistical significance in a large group. Application of these prognostic implications to the individual is limited by the frequency of false-negative tests and presumably the ability of collateral circulation to compensate for coronary artery insufficiency.