The objective of our study was to compare the discriminating power of a proposed ST segment/heart rate index with that of a standard method of assessing exercise-induced ST segment depression for diagnosing coronary artery disease. We used a cross-sectional retrospective analysis of exercise test and coronary angiographic data. The study took place in a 1,200-bed Veterans Affairs Medical Center; participants were 328 male patients who had undergone both a sign and symptom-limited treadmill test and coronary angiography. The sensitivity of the ST segment/heart rate index was 54% at a cut point of 0.021 mm/(beats/min), corresponding to a specificity of 73%. The standard visual ST segment analysis had a sensitivity of 58% at this same specificity, which corresponded to an ST segment cut point of 1-mm depression relative to rest (p = NS). Similarly, for diagnosing three-vessel or left main coronary disease, no significant difference was found between the sensitivities or the two measurements at cut points of equivalent specificity. In this consecutive series of patients presenting for routine clinical testing, the ST segment/heart rate index did not improve the diagnostic accuracy of the exercise test for identifying the presence or severity of coronary artery disease relative to standard visual criteria.