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Utility of exercise electrocardiography testing for the diagnosis of coronary artery disease in a remote Australian setting

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Coronary artery disease (CAD) remains the leading cause of death in Australia, both in the general population and also among Aboriginal and Torres Strait Islander peoples (referred to henceforth as Indigenous Australians).1 Indigenous Australians are three times as likely to suffer a major coronary event than are non-Indigenous Australians,2 and cardiovascular disease remains the leading cause of Indigenous mortality and the main contributor to the mortality gap between Indigenous and non-Indigenous Australians.3 Furthermore, the burden and severity of other diseases that predispose to CAD are higher among Indigenous Australians.4

Patients with an acute coronary syndrome (ACS), as defined by electrocardiography results and biochemical markers, proceed to coronary angiography, which is considered the gold standard diagnostic tool for CAD; however, its use is limited due to its invasive nature, cost and accessibility.5 In the absence of a definite ACS, less invasive, and often more accessible, exercise stress testing is used. Stress testing determines the significance of a patient’s symptoms by indicating…