October 20, 1993

Noninvasive Testing for Silent Myocardial Ischemia in Stable Coronary Patients

Author Affiliations

George Washington University Medical Center Washington, DC

JAMA. 1993;270(15):1809-1810. doi:10.1001/jama.1993.03510150043014

To the Editor.  —The study by Moss et al1 on the prognostic value of noninvasive testing after coronary events is a well-conceived but misinterpreted study. In the study and in a front-page newspaper story, Moss2 said these tests "failed to pinpoint those most at risk," that "Hillary Clinton would be very pleased with the results," and suggested that up to $1 billion a year is wasted on these "unnecessary tests." These gross generalizations are not supported by their data.First, we are told briefly that ischemia on the resting ECG, exercise ECG, and thallium tests was in fact associated with a (statistically significant?) increased rate of cardiac events defined in the traditional manner of death, recurrent myocardial infarction, unstable angina, or revascularization (coronary artery bypass graft [CABG] or percutaneous transluminal coronary angioplasty [PTCA]). Only when revascularization was not considered an end point did these associations lessen. Patients revascularized