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Unfortunately no randomized controlled trials have been performed to demonstrate that screening asymptomatic adults without known cardiovascular disease leads to improved outcomes. All that is available are observational studies to guide our efforts to screen and treat asymptomatic patients in an effort to minimize the risks of coronary heart disease (CHD) and sudden cardiac death (SCD). The findings of Laukkanen et al. 1 make a unique contribution to the literature in that they demonstrate the ability of the exercise ECG to predict SCD rather than just cardiac death. It is well established that the exercise ECG test can prognosticate CHD death. Using angiography as an endpoint, meta-analysis has suggested a mean sensitivity of 68% (range 23–100%) and a mean specificity of 77% (range 17–100%) for the exercise ECG.2 The only angiographic study designed to limit work-up bias has demonstrated more realistic test characteristics with a sensitivity of 45% and a specificity of 85%.3 A similar analysis in asymptomatic adults has … *Corresponding author. Email: vicmd{at}aol.com

Should the exercise ECG be used to screen for sudden cardiac death?