Heart rate adjustment of exercise-induced ST-segment depression - The better predictive tool

The value of heart rate adjustment of exercise-induced ST-segment depression for predicting death from coronary artery disease was evaluated during a seven-year follow-up of 5,940 men randomized to the usual-care group of the Multiple Risk Factor Intervention Trial. A positive ST-segment/heart rate index of 1.60 μV/beats per minute or higher identified a group of men at significantly increased risk for death and remained a strong independent predictor of death even after multivariate adjustment for age, diastolic blood pressure, serum cholesterol level, and tobacco use. In contrast, an abnormal exercise electrocardiographic result determined by standard criteria was not predictive of cardiac death. The findings of this study support the use of heart rate adjustment of ST-segment depression for stratifying the risk of death from coronary artery disease for asymptomatic high-risk persons.