Reassessing the Value of the Exercise Electrocardiogram in the Diagnosis of Stable Chest Pain

“Do not use exercise ECG to diagnose or exclude angina for people without known coronary artery disease” a quote from the summary (Cooper et al, 2010) of the guidelines of the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) on the diagnosis of discomfort of suspected cardiac origin (NICE, 2010). Amongst other things, NICE recommends that the probability of coronary artery disease (pCAD) is determined from the person’s symptoms and risk factors, and that the subsequent management depends on whether the pCAD is less than 10%, 10 to 30%, 30 to 60%, 60 to 90% or greater than 90%: if the pCAD is less than 10% or greater than 90% further testing is not required; if the pCAD is between 60 and 90%, the patient is a candidate for coronary arteriography; if the pCAD is between 10 and 60% non-invasive testing is indicated.