The popular belief that stress causes coronary events is now supported by many studies that have carefully excluded self-reporting bias, whether by monitoring post-bereavement mortality rates, increased episodes of ventricular tachycardia in patients with implantable cardioverterdefibrillators in response to natural disaster, or more recently, the reversible perfusion defects measured by single photon emission computed tomography (SPECT) in response to mental stressor administration in the laboratory. Indeed, mental stress ischemia may better predict ischemia during Holter monitoring than ischemia during exercise; it is also associated with a 3-fold relative increase in mortality rate. On that basis, mental stress testing could be effective in selecting at-risk patients for appropriate intervention...