Stress echocardiography compared to exercise ECG for the assessment of acute coronary syndrome
AbstractLetters to the Editor doi:10.1093/eurheartj/ehm185 Online publish-ahead-of-print 2 July 2007 We have read with interest the article by Jeetley et al. 1 on the comparison of the clinical and economic impact of stress echo and exercise ECG for the assessment of acute coronary syndrome in patients with normal troponin. They showed that the cost of the exercise ECG approach was higher, mainly because of the higher performance of angiographies in this group (33 vs. 19%), which matches with the risk stratiï¬cation achieved by each approach (intermediate or high risk by exercise ECG, 67%; by stress echo, 23%). In spite of this higher number of angiographies in the exercise ECG group, outcome was similar and revascularization procedures were the same (15 vs. 13, data from Figure 3). One might suspect that a signiï¬cant number of angiographies in the exercise ECG intermediate risk patients did not translate into revascularization procedures. We have performed a similar study in patients after acute myocardial infarction.2 In our study ischemia was more frequently detected by exercise echo than by exercise ECG (59 vs. 27%, P , 0.001) and therefore the number of angiographies and revascularization procedures were higher in the former group (59 vs.