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Exercise Testing Interpretation — EECC MCQ

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EasyCoronary Artery DiseaseExercise Testing InterpretationEECC

A 45-year-old woman undergoes exercise treadmill testing for investigation of exertional chest pain. She achieves 10 METs, with a peak heart rate of 170 bpm (95% predicted), no ST-segment changes, no arrhythmias, and a normal blood pressure response. Her pre-test probability of obstructive CAD was estimated at 15%. What is the most appropriate next step?

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Correct answer: E — Reassurance and discharge with no further cardiac investigation

With a low pre-test probability (15%) and a completely normal exercise test achieving excellent functional capacity (>10 METs, >95% predicted HR, no ischaemic ECG changes, normal BP response), the post-test probability of significant CAD is very low. No further investigation is needed. The 2024 ESC CCS Guidelines recommend CTCA as the first-line investigation for patients with low-intermediate PTP, but in this scenario the exercise test has already provided sufficient negative predictive information. A normal high-workload exercise test has a very high negative predictive value for major adverse cardiac events.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes