Why we might not need to stress about ruling out inducible myocardial ischemia

[Extract] In patients with symptoms of stable angina, cardiac stress testing and angiography have been recommended to evaluate for inducible myocardial ischemia and obstructive coronary artery disease (CAD). Walter and colleagues (1) investigated whether high-sensitivity cardiac troponin (hs-cTn) tests could be introduced in this diagnostic pathway. Because of the tests' high sensitivity for detecting myocardial injury, negative results are used to rule out acute coronary syndrome in patients presenting with acute chest pain, allowing safe discharge home from the emergency department (the tests' clinical utility for ruling in myocardial infarction is more uncertain [2]). Walter and colleagues (1) hypothesized that hs-cTn tests could be used in a similar way in patients with stable angina, such that a negative result would safely rule out inducible myocardial ischemia without the need for further tests.