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The usefulness of exercise Tl scintigraphy (combined with electrocardiography) in a district general hospital has been assessed in 80 patients in whom a previous exercise electrocardiogram (ECG) had not been definitive. Seventy-five of the patients presented with chest pain and five with no pain but an abnormal ECG. Case notes and test results were examined to establish the clinicians' judgment of the likelihood of having coronary heart disease (CHD) and the patient's outcome. The mean time of follow-up was 27 months. In the majority of patients the test was found to help the clinician come to a decision on the presence or absence of CHD. It was found to be particularly useful in patients with abnormal resting ECGs. There was a shorter time to discharge for patients classified as highly unlikely of having CHD. Only four patients were re-referred following discharge from the outpatient clinic. Nine patients were referred for coronary angiography with five being found to have significant stenosis. None of the 16 patients in whom the exercise ECG was normal had ischaemic myocardial segments in the Tl scintigraphy.