Practical significance of exercise stress test in individuals at low risk for atherosclerotic coronary artery disease

Sanjeev V Mangrulkar, Pramod Katare, Ashiwini Joshi

Astrocyte 2017 3(4):196-200

Background: Despite not finding favor with a number of apex global bodies including the American Heart Association, American College of Cardiology, United States Preventive Services Task Force, exercise stress test continues to be performed customarily among asymptomatic individuals to screen for potential presence of ischemic heart disease. Materials and Methods: This retrospective study comprises a successive total of 2042 individuals who were put through a screening stress test as a part of their health checkup package. A telephonic communication was made with all the persons who had been advised further assessment such as repeat stress test, drug therapy, stress thallium testing, or coronary angiography. The compliance of this group to the advice offered was noted along with their subjective sense of satisfaction with the overall process. Based on these inputs the practical utility of stress test was calculated as either good or poor. Results: Out of 2042 individuals who underwent stress test, 183 (9%) were reported as positive. Out of these 183 individuals only 132 with positive stress test could be contacted telephonically. After a detailed analysis of their compliance with the advice offered, it was noted that the screening had best practical utility when the test report was negative. Only one person with a positive report had followed the advice to the logical end by undergoing coronary artery bypass grafting and had a likely good practical utility. In rest of the scenarios, the practical utility was poor. Conclusion: The screening exercise stress tests are sought by most individuals as means of reassurance about health. Its practical significance in all other scenarios is poor. Therefore, unless definite indications exist, stress test should not be performed as a screening test.

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