The resting electrocardiogram as a screening test. A clinical analysis.

PURPOSE To review the evidence that a resting electrocardiogram (ECG) predicts cardiac disease in healthy persons and to discuss the role of this test in screening for coronary artery disease. DATA IDENTIFICATION A manual search of the English-language literature using Index Medicus (1970-1988) and a bibliographic review of identified articles. STUDY SELECTION We found 40 articles that described long-term survival of healthy individuals who either had had an abnormal finding on a resting ECG or had not had an abnormal finding. DATA EXTRACTION We pooled the pertinent studies and calculated the relative risk for coronary artery disease if an ECG finding was present and the 95% confidence limits (CI) on the relative risk. RESULTS OF ANALYSIS: One reason for doing a screening SCG is to detect disease whose effects can be prevented by early treatment. In population studies of healthy middle-aged men, frequent ventricular premature beats, left axis deviation, left ventricular hypertrophy (ECG-LVH), and changes indicative of myocardial ischemia are all associated with a small but statistically significant increase in the risk of dying from coronary artery disease. There is no evidence that early detection of these findings leads to a clinical intervention that improves health outcomes. A screening ECG can also serve as a "baseline" tracing. Two studies have shown that the baseline tracing has little effect on decision making in the emergency room. CONCLUSION The evidence does not support doing a screening ECG in men without evidence of cardiac disease or cardiovascular risk factors.