Background: There has been no clear consensus regarding the optimum definition of a high-risk exercise ECG test. The aim of this study is to compare the diagnostic accuracy of several treadmill scores [American College of Cardiology/American Heart Association (ACC/AHA) High-Risk Criteria for exercise testing, Duke Treadmill Score, Veterans Affairs and West Virginia Prognostic Score, ST/Heart Rate Index] with the ST-segment depression analysis in the detection of significant and severe coronary disease as determined by coronary angiography. Methods: The study included a cohort of 248 consecutive patients admitted to hospital for unstable angina. Results: The sensitivities of the ACC/AHA High-Risk Criteria and the ST depression ≧1 mm were 89.02 and 76.83%, respectively, for the detection of significant coronary artery disease, and 96.15 and 86.54% for the detection of severe coronary artery disease. The specificities of the Duke Treadmill Score and the ST depression ≧1 mm were 96.43 and 73.81%, respectively, for the detection of significant coronary artery disease, and 81.63 and 47.45% for the detection of severe coronary artery disease. Conclusions: The ACC/AHA High-Risk Criteria and Duke Treadmill Score provided relevant diagnostic information not available from the ST segment analysis alone.

Myocardial bridging is a congenital anomaly in which a segment of a coronary artery runs intramuscularly. Although traditionally considered as a benign condition, myocardial bridging may be associated with clinically important complications such as myocardial ischemia, acute coronary syndromes and sudden death. We report the case of a highly symptomatic 36 years old patient with a myocardial bridge in left anterior descending coronary artery in which surgical treatment was proposed. Previous to surgery a non invasive coronariography with cardiac CT was practised in order to define the anatomy.

The ACC/AHA High-Risk Criteria was West Virginia Prognostic Score provided relevant diagnostic information in patients with an intermediate DTS. A coronary angiography is to be recommended in patients with an intermediate DTS who also present ST-segment depression > or =1 mm and exercise-induced angina.

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