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Localizing Coronary Artery Obstructions with the Exercise Treadmill Test

DANIEL B. MARK, M.D., M.P.H.; MARK A. HLATKY, M.D.; KERRY L. LEE, Ph.D.; FRANK E. HARRELL Jr., Ph.D.; ROBERT M. CALIFF, M.D.; and DAVID B. PRYOR, M.D.
[+] Article and Author Information

Presented in part 12 March 1986 at the 35th Annual Scientific Sessions of the American College of Cardiology, Atlanta, Georgia.

▸Requests for reprints should be addressed to Daniel B. Mark, M.D.; P.O. Box 3485, Duke University Medical Center; Durham, NC 27710.


Durham, North Carolina


© 1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;106(1):53-55. doi:10.7326/0003-4819-106-1-53
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To determine if patterns of ST depression or elevation during exercise testing provide reliable information about the location of an underlying coronary lesion, we studied 452 consecutive patients with one-vessel disease who underwent treadmill testing. Exercise ST changes were classified as elevation or depression and by lead groups involved. The ST depression occurred most commonly in leads V5 or V6 regardless of which coronary artery was involved. In contrast, anterior ST elevation indicated left anterior descending coronary disease in 93% of cases, and inferior ST elevation indicated a lesion in or proximal to the posterior descending artery in 86% of cases. Furthermore, anterior ST elevation in leads without diagnostic Q waves usually indicated a high-grade, often proximal, left anterior descending stenosis, whereas anterior ST elevation in leads with Q waves usually indicated a totally occluded left anterior descending coronary artery. Thus, ST elevation during exercise testing, although uncommon, is a reliable guide to the underlying coronary lesion, whereas ST depression is not.

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