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Stress echocardiography safely classified more patients as low risk of serious CAD than exercise electrocardiography

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 Q In patients with suspected acute coronary syndrome and a negative cardiac troponin test, is stress echocardiography (SEcho) better than exercise electrocardiography (ExECG) for predicting risk of serious coronary artery disease (CAD)?

Clinical impact ratings Internal medicine ★★★★★★☆ Cardiology ★★★★★☆☆


Embedded ImageDesign:

randomised controlled trial.

Embedded ImageAllocation:

unclear allocation concealment.*

Embedded ImageBlinding:


Embedded ImageFollow up period:

median 8.7 months.

Embedded ImageSetting:

hospital in Harrow, Middlesex, UK.

Embedded ImagePatients:

433 patients (mean age 61 y, 57% men) with suspected acute coronary syndrome, non-diagnostic ECG, negative cardiac troponin test result, and ⩾2 risk factors for CAD. Patients with known CAD awaiting revascularisation were excluded.

Embedded ImageIntervention:

risk of CAD was determined by SEcho using either treadmill or pharmacological testing (n = 215) or ExECG (n = 218) (negative test  =  low risk, positive test  =  high risk, and inconclusive test  =  pretest risk as determined …

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  • * See glossary.

  • For correspondence: Dr R Senior, Northwick Park Hospital and Institute for Medical Research, Harrow, UK. roxysenior{at}

  • Sources of funding: Cardiac Research Fund and North West London Hospital Trust.