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. (September 15, 1989)