Relationship Between Exercise Electrocardiography Findings and Cardiovascular Events and the Extent of Coronary Artery Disease: What is New?

Objectives: The exercise treadmill test (ETT) is commonly used in cardiology practice. Detection of the severity of coronary artery disease (CAD) by the surrogates of ETT is of great importance to guide the management plan. Here, we aimed to identify the best ETT surrogates to detect the extent of CAD and major adverse cardiovascular events (MACE) during follow-up. Materials and Methods: This retrospective study included patients with positive ETT results for coronary ischemia who underwent invasive coronary angiography after the index ETT. The following surrogates of ETT were used in the study for the analyses: exercise duration; maximum workload achieved in METS; rate-pressure product (RPP) at rest, at peak, and at 3rd minute in the recovery; number of leads with ST deviation; and Duke treadmill score (DTS). Patients were classified into low-risk, intermediate-risk, and high-risk groups according to the SYNTAX score. The ETT findings of the groups were compared. Results: The study included 48 patients: low-risk group: 24 (50%); intermediate-risk group: 10 (21%); and high-risk group: 14 (21%). The average age was 50±8 years. DTS, peak RPP, recovery RPP, and number of leads with ST deviation were significantly different between the high-risk group and the other groups. These variables were well correlated with the SYNTAX score, presence of the left main coronary artery (LMCA) lesion, and development of MACE at follow-up. Conclusion: DTS, peak RPP, recovery RPP, and number of leads with ST deviation are well correlated with the extent of CAD, presence of LMCA lesions, and development of MACE at follow-up.