More articles from Choosing the Right Coronary Test

Abnormal hemodynamic responses to exercise may indicate an increased risk of coronary events and death, even without evidence of ischemia. Exercise duration and the blood pressure, heart rate, and heart rhythm responses to exercise have prognostic significance.

Technical advances have substantially improved the clinician’s ability to find and describe coronary disease. They also pose a bewildering array of choices.

In patients with a normal resting electrocardiogram and no prior revascularization, a regular exercise stress test without imaging should suffice. However, no randomized trials have been done to determine if this strategy leads to better outcomes than empiric therapy does.