Use of the ambulatory ECG to diagnose coronary artery disease

Summary Forty-nine patients undergoing cardiac catheterization for suspected coronary artery disease (CAD) were monitored with a two-channel ambulatory ECG and were given maximal treadmill exercise tests when these were not contraindicated. The ambulatory ECG recordings were evaluated for the number of ST segment deviations after correction for positional changes, and the results were then compared with those of the exercise test and coronary angiography. Sensitivity and specificity of ambulatory ECG monitoring for ST segment deviations to detect CAD were 76% and 75% respectively while those of exercise testing were 78% and 63% respectively. Sixteen patients (33% of this series) had equivocal or contraindicated exercise tests and twelve of these patients were correctly classified as to the presence or absence of CAD by ambulatory ECG. ST segment deviations on ambulatory ECG were found in 93% of patients with three vessel, two vessel, or one vessel LAD disease, while exercise testing detected 74% of these patients. Ambulatory ECG is an effective non-invasive method to diagnose CAD and is complementary to exercise testing. It is of special value when the exercise test is equivocal or contraindicated.