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Limitations of Continuous Ambulatory Electrocardiogram Monitoring for Detecting Coronary Artery Disease

MICHAEL H. CRAWFORD, M.D.; CARLOS A. MENDOZA, M.D.; ROBERT A. O'ROURKE, M.D., F.A.C.P.; DAVID H. WHITE, M.D.; CHARLES A. BOUCHER, M.D.; and JEFFREY GORWIT, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Michael H. Crawford, M.D.; The University of Texas Health Science Center at San Antonio; 7703 Floyd Curl Drive; San Antonio, TX 78284.


San Antonio, Texas, and San Diego, California


© 1978 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1978;89(1):1-5. doi:10.7326/0003-4819-89-1-1
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To assess the value of continuous ambulatory electrocardiogram (ECG) monitoring for detecting coronary artery disease in symptomatic patients, we evaluated 70 patients with chest pain and normal resting ECGs prospectively by calibrated ambulatory monitoring, graded treadmill exercise, and selective coronary cineangiography. Ischemic-type ST-wave changes were detected by monitoring in 24 of the 39 patients with coronary artery disease (62% sensitivity). Twenty-six of the 39 patients had a positive treadmill (67% sensitivity). Of the 31 patients without coronary disease on angiography, 19 had negative monitoring studies (61% specificity). The treadmill was negative in 23 of these 31 patients (75% specificity). When the results of both tests were combined, 85% of the cases of coronary artery disease were detected, but only 52% of the patients without disease had negative studies. We conclude that continuous ambulatory monitoring is of limited value for detecting or excluding coronary artery disease in symptomatic patients with normal resting ECGs.

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