Evidence on harms was limited , but direct harms seemed minimal ( for resting ECG ) or small ( for exercise ECG ) .
BACKGROUND Coronary heart disease is the leading cause of death in adults .
Screening for abnormalities by using resting or exercise electrocardiography ( ECG ) might help identify persons who would benefit from interventions to reduce cardiovascular risk .
PURPOSE To up date the 2004 U.S. Preventive Services Task Force evidence review on screening for  resting or exercise ECG abnormalities in asymptomatic adults .
Is exercise testing useful to improve the prediction of coronary events in asymptomatic subjects?
Objective The value of exercise testing ( ET ) in asymptomatic subjects remains controversial and is unknown in countries with a low coronary heart disease ( CHD ) incidence . The aim of this study was to investigate the ability of ET to improve the prediction of a first coronary event in such a population . Methods Using a prospect i ve cohort study , 1051 consecutive healthy asymptomatic adults were enrolled in a cardiovascular screening program including ET .  The pre-test risk of CHD was evaluated by the 10-year Framingham risk function . Positive ET was defined as a horizontal or downsloping ST-segment depression ≥ 1.0 mm . The primary outcome was total coronary events ( CE ) occurrence , including cardiac deaths , acute myocardial infa rct ion and stable or unstable angina . The mean follow-up period was 6 years . Results Subjects were aged 18 - 79 years and 36 % were women . A total of 89 subjects ( 8.5 % ) had a positive ET .  Positive exercise testing was associated with CE occurrence in a univariate analysis only in subjects with higher pre-test risk , defined by a 10-year Framingham risk > 10.4 % [ hazards ratio ( HR ) = 2.61 ; 95 % confidence interval ( CI ) ( 1.07 - 6.40 ) ] . In this risk category , ET was able to provide incremental information over the major risk factors in both men and women [ risk factor-adjusted HR for positive ET = 2.86 ; 95 % CI ( 1.14 - 7.20 ) ] . This risk excess in subjects with positive ET persisted even when a coronary revascularization was performed . Subjects with intermediate pre-test probability ( 10 - 15 % ) and positive ET had a post-test probability of CE largely equivalent to the probability in subjects with known CHD . Conclusion Additional informátion provided by ET in subjects with a pre-test risk at 10-years > 10 % should lead to a more efficient use of risk-reducing therapies than it would be the case in this risk category with the analysis of traditional risk factors only
Evidence on harms was limited , but direct harms seemed minimal ( for resting ECG ) or small ( for exercise ECG ) .
BACKGROUND Coronary heart disease is the leading cause of death in adults .
Screening for abnormalities by using resting or exercise electrocardiography ( ECG ) might help identify persons who would benefit from interventions to reduce cardiovascular risk .
PURPOSE To up date the 2004 U.S. Preventive Services Task Force evidence review on screening for  resting or exercise ECG abnormalities in asymptomatic adults .