title: Exercise-induced ST depression and ST/heart rate index to predict triple-vessel or left main coronary disease: a multicenter analysis.
abstract: The aim of this investigation was to determine the difference in accuracy between two frequently published noninvasive indicators of severity of coronary artery disease (exercise-induced ST segment depression and heart rate-adjusted ST depression [ST/HR index]). The study was designed as a survey of consecutive patients undergoing exercise electrocardiography and coronary angiography. There were a total of 2,270 patients without prior myocardial infarction or cardiac valvular disease referred for angiography from eight institutions in three countries; 401 of these patients had triple-vessel or left main coronary artery disease. The sensitivities of ST depression and ST/HR index in detecting triple-vessel or left main coronary artery disease were, respectively, 75% and 78% (p = 0.08) at cut point values where their specificities were equal (64%). This small increase in the accuracy of the ST/HR index was evident only at peak exercise heart rates below the median value of 132 beats/min, where the sensitivities of ST depression and ST/HR index were 73% and 76% (p = 0.03), respectively, at cut point values corresponding to a specificity of 60%. These results were consistent at all eight participating institutions. The increase in accuracy achieved by dividing exercise-induced ST depression by heart rate is small and confined exclusively to a low exercise heart rate. This lack of superiority cannot be generalized to all methods of heart rate adjustment.
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, Long Beach, California.
authors.forename: M
authors.initials: M
authors.lastname: Bobbio
authors.forename: R
authors.initials: R
authors.lastname: Detrano
authors.forename: J J
authors.initials: JJ
authors.lastname: Schmid
authors.forename: A
authors.initials: A
authors.lastname: Janosi
authors.forename: A
authors.initials: A
authors.lastname: Righetti
authors.forename: M
authors.initials: M
authors.lastname: Pfisterer
authors.forename: W
authors.initials: W
authors.lastname: Steinbrunn
authors.forename: K H
authors.initials: KH
authors.lastname: Guppy
authors.forename: P
authors.initials: P
authors.lastname: Abi-Mansour
authors.forename: J W
authors.initials: JW
authors.lastname: Deckers
mesh_terms: D015982:Bias; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012017:Referral and Consultation; D014481:United States / Q000453:epidemiology