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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 ★★★★★☆☆
METHODS
Design:
randomised controlled trial.
Allocation:
unclear allocation concealment.*
Blinding:
unblinded.*
Follow up period:
median 8.7 months.
Setting:
hospital in Harrow, Middlesex, UK.
Patients:
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.
Intervention:
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 …
Footnotes
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↵* See glossary.
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For correspondence: Dr R Senior, Northwick Park Hospital and Institute for Medical Research, Harrow, UK. roxysenior{at}cardiac-research.org
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Sources of funding: Cardiac Research Fund and North West London Hospital Trust.
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