Comparison of the Diamond-Forrester method and a new score to estimate the pretest probability of coronary disease before exercise testing.
OBJECTIVE
We compared the Diamond-Forrester (DF) tabular method to assess pretest probability of coronary artery disease to a new scoring method (NS).


METHODS
We evaluated 544 patients with suspected coronary disease who underwent both exercise electrocardiography and coronary angiography. The prevalence of any coronary artery disease (CAD) (>/=1 vessel with a >/=50% stenosis) within low, intermediate, and high pretest probability groups defined by the 2 methods was compared. The DF method used age, sex, and symptoms. The NS used those 3 factors plus 7 other risk factors.


RESULTS
Overall prevalence of CAD was 41%. We compared the respective prevalence of CAD within pretest probability groups. Low probability: DF 27% versus NS 17% (P <.03); intermediate probability: DF 42% versus NS 47%; high probability: DF 70% versus NS 72%. We evaluated results separately in men and women. In women, no significant differences were found. However, in men, a significant difference in the low probability group was found (DF 47% versus NS 22%; P <.03). When the 47 asymptomatic patients were removed from the analysis, there were no differences between the 2 methods. Men: low probability, DF 17% versus NS 21%; intermediate probability, DF 45% versus NS 49%; high probability, DF 67% versus NS 72%. Women: low probability, DF 17% versus NS 15%; intermediate probability, DF 38% versus NS 27%; high probability, DF 83% versus NS 70%.


CONCLUSIONS
In symptomatic patients, the accuracy of the 2 methods was the same. In asymptomatic patients, further evaluation in larger populations will be needed.
Morise
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AP
Section of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, 26506, USA.
D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors