Incremental prognostic value of the exercise electrocardiogram in the initial assessment of patients with suspected angina: cohort study

Angina is and remains a clinical diagnosis and this article obviously
confirms this. It is quite possible to do a PTCA and a CABG prodecure on
somebody with angiographically demonstrated laesions. That does not mean
that these symptoms necessarily relate to the angiographic findings and to
a improved result and I have seen patients who clearly have not benfitted
from the procedure for that reason. We should bear in mind that PTCA or
CABG are in essence palliative procedures after failed medical treatment.
We do find co-incidently patients with proximal disease and they
retrospectively have an improved survival prognosis. However we do not
routinely screen for this. The message therefore remains: angina is a
clinical diagnosis based on history and physical examination with
sometimes help from an excercise stress test and ECG. The treatment we
offer is palliative in all cases with prognostic survival benefits in a
subgroup, we can only identify retrospectively.

Competing interests:
None declared