Limitations of Continuous Ambulatory Electrocardiogram Monitoring for Detecting Coronary Artery Disease

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Abstract
To assess the value of continuous ambulatory ECG monitoring for detecting coronary artery disease in symptomatic patients, 70 patients with chest pain and normal resting ECG were prospectively evaluated by calibrated ambulatory monitoring, graded treadmill exercise and selective coronary cineangiography. Ischemic-type ST-wave changes were detected by monitoring in 24 of the 39 patients with coronary artery disease (62% sensitivity). Twenty-six of the 39 patients had a positive treadmill (67% sensitivity). Of the 31 patients without coronary disease on angiography, 19 had negative monitoring studies (61% specificity). The treadmill was negative in 23 of these 31 patients (75% specificity). When the results of both tests were combined, 85% of the cases of coronary artery disease were detected, but only 52% of the patients without disease had negative studies. Continuous ambulatory monitoring is of limited value for detecting or excluding coronary artery disease in symptomatic patients with normal resting ECG.

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