Coronary disease & ACSCohort study
Prognostic importance of exercise electrocardiography in patients with suspected microvascular disease
- single-centre observational study
- consecutive patients
Authors' conclusion
In patients with suspected CMD, ischaemic ST-segment changes are of limited prognostic value, showing poor sensitivity and low PPV for the occurrence of MACE. However, reduced exercise capacity was an independent risk factor and, therefore, ex-ECG testing could be considered if a functional assessment of patients is warranted.
Study context
- Population
- Chest pain patients with suspected coronary microvascular dysfunction (CMD) (ischaemia due to epicardial coronary stenosis ruled out by MPS)final study cohort, 1021 consecutive patients examined, 113 excluded due to inconclusive ex-ECG findings or missing data and 148 due to ischaemia on MPS
- Participants
- 760 patients
- Exposure
- Abnormal vs normal ex-ECG for major adverse cardiac events (MACE)
- abnormal ex-ECGn = 126
Main finding
As reported in the abstract
MACE:
- Cardiovascular death
- Myocardial infarction
- Unstable angina
- Unplanned revascularisation
Hazard ratio
1.1
CI 0.7–1.7
P = 0.6
Events by group
Abnormal vs normal ex-ECG for MACE
HR 1.1 (CI 0.7–1.7); P = 0.6
- Kaplan-Meier curves for cumulative events separated significantly
- log-rank p=0.01
Observational data: associations, not effects.
Further findings
Prognostic PPV of an abnormal ex-ECG
- All patients
- 25% (31/126)
- Excluding patients with known coronary artery disease (n=323)
- 17% (11/66)
Original publication
Prognostic importance of exercise electrocardiography in patients with suspected microvascular disease. Heart. Published 13 February 2026. doi:10.1136/heartjnl-2025-327173
Summarised from the published abstract; every number is checked against it