EDITORIAL Should the exercise ECG be used to screen for sudden cardiac death?

This editorial refers to ‘Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study’†, by J.A. Laukkanen on page 558 Unfortunately no randomized controlled trials have been per-formed to demonstrate that screening asymptomatic adults without known cardiovascular disease leads to improved out-comes. All that is available are observational studies to guide our efforts to screen and treat asymptomatic patients in an effort to minimize the risks of coronary heart disease (CHD) and sudden cardiac death (SCD). The findings of Laukkanen et al.1 make a unique contribution to the literature in that they demonstrate the ability of the exercise ECG to predict SCD rather than just cardiac death. It is well established that the exercise ECG test can prognosticate CHD death. Using angiography as an endpoint