Harold C. Sox Jr., MD; Alan M. Garber, MD, PhD; Benjamin Littenberg, MD
Purpose: To review the evidence that a resting electrocardiogram (ECG) predicts cardiac disease in healthy persons and to discuss the role of this test in screening for coronary artery disease.
Data Identification: A manual search of the Englishlanguage literature using Index Medicus (1970-1988) and a bibliographic review of identified articles.
Study Selection: We found 40 articles that described longterm survival of healthy individuals who either had had an abnormal finding on a resting ECG or had not had an abnormal finding.
Data Extraction: We pooled the pertinent studies and calculated the relative risk for coronary artery disease if an ECG finding was present and the 95% confidence limits (CI) on the relative risk.
Results of Analysis: One reason for doing a screening ECG is to detect disease whose effects can be prevented by early treatment. In population studies of healthy middle-aged men, frequent ventricular premature beats, left axis deviation, left ventricular hypertrophy (ECG-LVH), and changes indicative of myocardial ischemia are all associated with a small but statistically significant increase in the risk of dying from coronary artery disease. There is no evidence that early detection of these findings leads to a clinical intervention that improves health outcomes. A screening ECG can also serve as a "baseline" tracing. Two studies have shown that the baseline tracing has little effect on decision making in the emergency room.
Conclusion: The evidence does not support doing a screening ECG in men without evidence of cardiac disease or cardiovascular risk factors.
Harold C. Sox, Alan M. Garber, Benjamin Littenberg. The Resting Electrocardiogram as a Screening Test: A Clinical Analysis. Ann Intern Med. 1989;111:489–502. doi: 10.7326/0003-4819-111-6-489
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Published: Ann Intern Med. 1989;111(6):489-502.
Cardiac Diagnosis and Imaging, Cardiology, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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