In patients with 3‐vessel coronary artery disease (3VD), perfusion defects in multiple vascular territories may not always be evident because of globally reduced perfusion. The diagnostic value of an exercise stress test (EST) versus a pharmacological stress test (PST) to detect 3VD is not well established in the literature.


We reviewed all coronary angiographies (CAs) done at Harrisburg Hospital between January 2002 and July 2002 (n = 900). Inclusion criteria were: patients 18 years or older who had had a CA and a nuclear stress test within 30 days of each other. Exclusion criteria were history of coronary artery bypass grafting or a cardiac event that had occurred between the time of the stress test and the CA.


As expected, patients who had 3VD (n = 36) were a higher‐risk population than those who did not have 3VD (n = 62). Among patients with 3VD, 11 had an EST, and 25 had a PST (P < .001). Although the nuclear test results were comparable for both modalities of stress testing (P = 1.0), more patients who underwent EST had chest pain (P = .05) or had a positive stress electrocardiogram, ECG (P = .001).

Stress Test Results for 3VD and Control Group Patients


EST is more likely to cause frank ischemia than is a pharmacological stress test, and it yields more clinical data such as chest pain or ECG changes. EST has better diagnostic value than PST in patients with 3VD. Whenever a high‐risk patient is capable of performing either test, EST should be the modality of choice because of its higher sensitivity to detect 3VD in a high‐risk population. Special emphasis should be placed on electrocardiogram stress test results and transient ischemic dilatation.

Author Disclosure:

M. Badov, None; V. V. Dimov, None; W. H. Fares, None; A. Aneja, None; A. Kumar, None; R. Hebbar, None; R. Moradkhan, None; J. Mandak, None.