ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1675602
This article is part of the Research TopicOptimizing Revascularization and Conservative Therapy in Chronic Coronary SyndromeView all 14 articles
Predictive value of electrocardiogram exercise stress test for the presence or absence of left main disease
Provisionally accepted
Saverio Tremamunno1
Nello Cambise1Angelo Giuseppe Marino1,2Fabio De Benedetto1,2Ludovica Lenci2Cristina Aurigemma1Carlo Trani1,2Francesco Burzotta1,2
Gaetano Antonio Lanza1,2*- 1Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
- 2Universita Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
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Background. The ability of electrocardiogram exercise stress test (ECG-EST) in excluding the presence of left main (LM) coronary artery disease (CAD) has poorly been investigated. Methods. We retrospectively selected patients who underwent both ECG-EST and elective invasive coronary angiography (ICA) at our Institution between January 2018 and December 2023 because of angina pain suspected of obstructive CAD. Preventively defined individual and combined ECG-EST variables suggesting no/mild myocardial ischemia were assessed as predictors of the absence of LM disease. Some ECG-EST variables suggesting extensive/severe myocardial ischemia were instead assessed as predictors of the presence of LM disease, defined as a stenosis ≥50% of the left main artery. This is a provisional file, not the final typeset article Results. Overall, 515 patients were included (age 66.2±11 years; 74% men). LM disease at ICA was found in 26 patients (5%). Individual and combined ECG-EST variables showed low positive predictive values for LM-CAD (maximum 13.5% for a combination of maximal ST-segment depression [STD] >2 mm and ECG-EST duration <360 min). The negative predictive value, however, was very high for some combined ECG-EST variables. Very low risk of LM disease (≤2.5%) was particularly shown in patients with peak heart rate (HR) ≥75% of maximal predicted HR for age and STD<2 mm (prevalence 63.1%; risk 2.2%) and peak HR ≥85% of maximal predicted HR for age and maximal STD<2 mm (prevalence 46.2%; risk 2.5%). Conclusions. Our data show that, among patients with angina chest pain suspected of obstructive CAD, ECG-EST results can reliably identify patients at very low risk of LM disease at coronary angiography.
Keywords: Coronary Artery Disease, Left main disease, electrocardiogram exercise stress test, invasive coronary angiography, Negative predictive value
Received: 29 Jul 2025; Accepted: 12 Sep 2025.
Copyright: © 2025 Tremamunno, Cambise, Marino, De Benedetto, Lenci, Aurigemma, Trani, Burzotta and Lanza. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gaetano Antonio Lanza, gaetanoantonio.lanza@unicatt.it
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