Exercise-induced ST depression and ST/heart rate index to predict triple-vessel or left main coronary disease: a multicenter analysis.
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.
Bobbio
M
M
Division of Cardiology, Veterans Affairs Medical Center, Long Beach, California.
Detrano
R
R
Schmid
J J
JJ
Janosi
A
A
Righetti
A
A
Pfisterer
M
M
Steinbrunn
W
W
Guppy
K H
KH
Abi-Mansour
P
P
Deckers
J W
JW
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