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The predictive of the functional tests compared to the anatomical tests in the diagnosis of coronary artery disease (CAD) is still debated. Cost-effectiveness ratio play a primary role in the best application of clinical practice.Methods 3200 pts (1600 men and 1600 women) were selected during a medical and cardiological screening. Two groups. The first one: evaluation or absence of events and the second one: presence of CAD. Evaluated datas: risk factors (FRC) and presence of clinical parameters limiting the predictive value of the Stress ECG from Effort (EE) such as: ECG’s abnormalities, branch blocks, hypertrophic, cardiomyopathy, gender. FRC evaluated parameters: hypertension 2080 (65.5%: 1040m; 1040f), hypercholesterolemia 1084 (37%: 592m; 592f), smoking 595 (18.6%: 298m; 297f), familiarity 1088 (34%: 1038m; 1042f), anxiety, depression, dystonia 1210 (37.8%: 430m-35% | 780f-65%), diabetes 320 (10%: 176m-55% 144f-45%).Results 900 pts were subjected to ESE: 540m 360w. Outcome at 1 year of CAD for mortality due to myocardial infarction, hospitalization for unstable angina major complications (CM): no pts. After ESE coronary angiography (CG) followed in 60 pts (7%): revascularizations (PTCA/CABG) 8 (1%: all men). ESE/CG correspondence in 100%. Comparison of CAD without revascularizations, ie diffuse atheromasia with sub-critical stenosis 35 (4%: 9m-25%, 26f-75%) all in primary evaluation without events and all hypertensive, evaluable as vasospastic ischemia (ie: x syndrome). Nobody pts was exposed to further radioactive stress procedures.Conclusions the functional test with ESE is confirmed as a valid tool, in term of cost-effectiveness also, in the screening and follow-up of CAD. Women and pts with multiple risk factors are different in the development of CAD. They are more exposed to the risk of an unappropriated and useless investigations, also radioactive. In general, ESE improves the prognosis and cost- effectiveness ratio in management of the pts with CAD.

P1822 Exercise stress echo in the preventive assessment of the coronary heart disease: experience in the real life practice