CONTEMPORARY CLINICAL PRACTICE OF EXERCISE ELECTROCARDIOGRAPHIC TESTING IN PATIENTS WITH CHEST PAIN: TEST PARADOX

초록

Background Exercise stress electrocardiographic testing (EST) is a widely used, low-cost, noninvasive tool, but sex-based differences in physiology, anatomy, and CAD prevalence have limited its use. In Korea, where invasive angiography is frequently performed, we aimed to evaluate contemporary practice patterns of EST and its relationship with patient characteristics and CAG findings. Methods Patients undergoing elective CAG for chest pain in outpatient clinic were identified from the national-wide multicenter prospective registry of the KoRean wOmen’S chest Pain rEgistry, between November 2013 and December 2023. Patient demographics, risk factors, symptoms, and EST results were correlated with the presence of OCAD. OCAD was defined as ≥50% stenosis in any epicardial coronary artery or its major branches. Results Of 2,517 patients undergoing elective angiography (mean age 63), 62.5% were women and 40.8% had obstructive CAD (OCAD), more frequent in men (46.6% vs 37.3%). EST was performed in 58.4% overall, less in women than men (51.7% vs 69.5%). OCAD was paradoxically more common in patients without EST (50.5% vs 33.8%, p<0.001), particularly in women (48.0% vs 27.3%, p<0.001). Patients without EST had higher prevalence of hypertension, diabetes, and greater use of cardioprotective medications. Women without EST had higher pre-test probability than those with EST, while in men the median PTP was similar. Among patients with intermediate PTP, EST utilization was lower in women than men (54.1% vs 71.2%). Conclusion In current practice, about 58% of patients who visit for chest pain in outpatient clinic undergo EST prior to elective CAG, and women had significantly less. The prevalence of OCAD is about 40% and paradoxically, OCAD is more prevalent in patients without EST. These results provide further impetus for improving pre-CAG assessment of likelihood of OCAD.