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Diagnosis and Treatment |

The Resting Electrocardiogram as a Screening Test: A Clinical Analysis

Harold C. Sox Jr., MD; Alan M. Garber, MD, PhD; and Benjamin Littenberg, MD
[+] Article and Author Information

Grant Support: Supported in part by the Blue Cross-Blue Shield Association.

Requests for Reprints: Harold C. Sox, Jr., MD, Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756.

Current Author Addresses: Drs. Sox and Littenberg: Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756. Dr. Garber: Department of Medicine, Division of General Internal Medicine, Stanford University Medical Center, Stanford, CA 94305-5475.


© 1989 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1989;111(6):489-502. doi:10.7326/0003-4819-111-6-489
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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.

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