Management of the Asymptomatic Patient With an Abnormal Exercise Electrocardiogram-Reply

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In Reply.— We appreciate the comments of Dr Lewis, but a careful reading of our article demonstrates that we did not advocate the approaches attributed to us by him. First, we do not recommend performing exercise electrocardiography on asymptomatic individuals in most circumstances. In fact, we explicitly stated that "because of the inefficiencies of testing for coronary disease in people at low risk for having this disease... [they] probably should not undergo stress ECG testing unless public safety demands it." The article deals with how to manage the patient whoalreadyhas undergone a stress ECG that is "positive." Even here, we do not advocate, in Dr Lewis' words, "an array of further testing." Rather, we discuss a reasoned approach to deciding for whom further testing is indicated; this approach, of course, includes the history taking mentioned by Dr Lewis. Additionally, we state that with a low-risk subset of asymptomatic

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