Assessment of chest pain in a low risk patient: is the exercise tolerance test obsolete?

The coronary artery calcium score has high sensitivity for detecting coronary stenosis—so a negative result makes significant coronary stenosis unlikely—but low specificity, and 60% of those without coronary artery disease will also have a positive result


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Thus many low risk patients may be diagnosed with coronary artery disease using the calcium score, although they may have clinically insignificant or “bystander” disease. These patients may benefit little from investigation and treatment and may be harmed


The exercise tolerance test is a quick, functional investigation that measures maximum exercise tolerance. In low risk patients who are likely to achieve a high workload the test can identify patients with high relative survival without the need for further imaging

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