Diagnostic testing for coronary artery disease frequently involves functional stress testing where imaging is often coupled with electrocardiogram (ECG) analysis. While decision-making is straightforward when both functional testing and ECG are either positive or negative, interpretation is challenging and prognostic importance uncertain with positive ECG and negative imaging since imaging is considered more sensitive. Prior studies have demonstrated mixed results. We sought to perform a meta-analysis of published studies to determine the significance of this particular type of discordant stress test result. PubMed, Cochrane, and Google Scholar were searched to identify studies reporting results of functional imaging (pharmacological exercise echocardiography or SPECT) and ECG analysis, along with the major adverse cardiovascular events (MACE) at patient follow-up. Studies were stratified based on functional imaging modality used. Primary outcome was a composite of all-cause death or myocardial infarction, and secondary outcome was the need for coronary revascularization. Random effects model was used to calculate risk ratios (RR), and heterogeneity among studies was assessed using the Higgins I value. Nine studies with a total of 23,715 patients were included. Primary end point was more common with discordant results with exercise stress echocardiography (RR 1.33, 95% confidence intervals [1.08–1.63]) or pharmacological SPECT (RR 6.53 95% CI [2.31–18.48]). Patients in the discordant exercise stress echocardiography and pharmacological SPECT groups were more likely to suffer the primary end point than those with a normal stress test. Discordant results should be interpreted carefully in the clinical context, given their prognostic impact based on the stress modality used.

中文翻译：

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压力测试期间异常压力心电图与正常心脏成像的意义——一项荟萃分析

冠状动脉疾病的诊断测试经常涉及功能压力测试，其中成像通常与心电图（ECG）分析相结合。虽然当功能测试和心电图均为阳性或阴性时，决策很简单，但对于阳性心电图和阴性成像，解释具有挑战性且预后重要性不确定，因为成像被认为更敏感。先前的研究表明结果好坏参半。我们试图对已发表的研究进行荟萃分析，以确定这种特定类型的不一致压力测试结果的重要性。检索了 PubMed、Cochrane 和 Google Scholar，以确定报告功能成像（药理学运动超声心动图或 SPECT）和心电图分析结果的研究，以及患者随访时的主要不良心血管事件 (MACE)。根据所使用的功能成像模式对研究进行分层。主要结局是全因死亡或心肌梗死的综合结果，次要结局是需要冠状动脉血运重建。使用随机效应模型计算风险比（RR），并使用 Higgins I 值评估研究之间的异质性。纳入了 9 项研究，总共 23,715 名患者。主要终点更常见于运动负荷超声心动图（RR 1.33，95%置信区间[1.08–1.63]）或药理学SPECT（RR 6.53 95% CI [2.31–18.48]）结果不一致的情况。运动负荷超声心动图和药理学 SPECT 组不一致的患者比负荷测试正常的患者更有可能出现主要终点。考虑到基于所使用的应激方式的预后影响，不一致的结果应在临床背景下仔细解释。