S-T-Segment Depression with Near-Maximal Exercise in Detection of Preclinical Coronary Heart Disease

Three hundred and fourteen male insurance underwriters had near-maximal treadmill exercise tests after having been evaluated for coronary risk factors. Thirty subjects developed ischemic-type S-T-segment depression during or after exercise not associated with anginal pain. The abnormal electrocardiographic response correlated significantly with elevated serum cholesterol, abnormal rest electrocardiogram, and history of cardiac symptoms; but not with smoking, high blood pressure, physical inactivity, or family history of coronary disease.In 2.5 years' follow-up there have been among the 30 ischemic responders to exercise testing three coronary deaths, four myocardial infarctions, two who developed angina pectoris, and one who had a coronary angiogram showing multiple obstructions. None of the normal responders to exercise testing has had a coronary event.