This is because the stress test compares the patients coronary flow status before and after exercise and is suitable to detecting specific areas of ischemia and lumen narrowing, not a generalized arterial thickening.According to American Heart Association data, about 65% of men and 47% of women present with a heart attack or sudden cardiac arrest as their first symptom of cardiovascular disease. Stress tests, carried out shortly before these events, are not relevant to the prediction of infarction in the majority of individuals tested. Over the past two decades, better methods have been developed to identify atherosclerotic disease before it becomes symptomatic. These detection methods include anatomical and physiological methods. Examples of anatomical methodsCT coronary calcium score
Coronary CT angiography
Intima-media thickness (IMT)
Intravascular ultrasound (IVUS)Examples of physiological methodsLipoprotein analysis
HbA1c
Hs-CRP
HomocysteineThe anatomic methods directly measure some aspects of the actual process of atherosclerosis itself and therefore offer the possibility of early diagnosis but are often more expensive and may be invasive (in the case of IVUS, for example). The physiological methods are often less expensive and safer but are not able to quantify the current status of the disease or directly track progression. Contraindications and termination conditions
Stress cardiac imaging is not recommended for asymptomatic, low-risk patients as part of their routine care. Some estimates show that such screening accounts for 45% of cardiac stress imaging, and evidence does not show that this results in better outcomes for patients.
However, an exercise stress test may provide more information about exercise tolerance than a pharmacologic stress test.Commonly used agents include:

Vasodilators acting as adenosine receptor agonists, such as adenosine itself, and dipyridamole (brand name "Persantine"), which acts indirectly at the receptor. Regadenoson (brand name "Lexiscan"), which acts specifically at the adenosine A2A receptor, thus affecting the heart more than the lung. Dobutamine. The effects of beta-agonists such as dobutamine can be reversed by administering beta-blockers such as propranolol.Lexiscan (Regadenoson) or Dobutamine is often used in patients with severe reactive airway disease (asthma or COPD) as adenosine and dipyridamole can cause acute exacerbation of these conditions. If the patients Asthma is treated with an inhaler then it should be used as a pre-treatment prior to the injection of the pharmacologic stress agent. In addition, if the patient is actively wheezing then the physician should determine the benefits versus the risk to the patient of performing a stress test especially outside of a hospital setting. Caffeine is usually held 24 hours prior to an adenosine stress test, as it is a competitive antagonist of the A2A adenosine receptor and can attenuate the vasodilatory effects of adenosine.Aminophylline may be used to attenuate severe and/or persistent adverse reactions to Adenosine and Lexiscan. Limitations
The stress test does not detect:
Atheroma
Vulnerable plaquesThe test has relatively high rates of false positives and false negatives compared with other clinical tests. Females in particular have a higher rate of false positives, which is theorized to be because on average they have smaller hearts.