Nuclear exercise testing and the management of coronary artery disease.
Three hundred seventy-eight patients referred for nuclear exercise testing were classified using demographics and symptoms into low, intermediate, and high coronary disease likelihood categories. These likelihood groups constituted 15%, 41%, and 15% of referrals, respectively. Patients with prior infarction or disease at angiography (proven disease) made up the remaining 29% of patients. Only 2% of low likelihood patients had typical angina, but physicians diagnosed coronary disease in 64%, prescribed antianginal therapy in 50%, and were considering catheterization in 28% of these patients, all as frequently as for patients with intermediate or high likelihoods for disease. Patients with proven disease were treated differently in that 79% were receiving antianginal therapy and 56% were considered for catheterization (p less than 0.001). Nuclear exercise test results reduced the perceived need for catheterization in all groups, on average by 49%. Nuclear exercise tests are a standard by which patients are managed, sometimes substituting for the traditional role of the history in physician decision making.
Steingart
R M
RM
Department of Medicine, Winthrop-University Hospital, State University of New York, Stony Brook, Mineola.
Wassertheil-Smoller
S
S
Tobin
J N
JN
Wexler
J
J
Budner
N
N
D001499:Bayes Theorem; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011877:Radionuclide Imaging; D012017:Referral and Consultation; D011795:Surveys and Questionnaires