Development and validation of a simple exercise test score for use in women with symptoms of suspected coronary artery disease.
BACKGROUND
Recently revised American College of Cardiology/American Heart Association guidelines for exercise electrocardiography (ExECG) have suggested that ExECG scores be used to assist in management decisions in patients with suspected coronary artery disease (CAD).


METHODS
We used 442 women who underwent both ExECG and coronary angiography (CAD > or =1 lesion with > or =50% stenosis; CAD prevalence was 32%) to derive an ExECG score including clinical and ExECG variables. By use of logistic regression analysis, variables were selected and relative weights were determined. Variable codes multiplied by respective weights were summed to produce a final ExECG score. The score was validated in separate populations concerning angiographic as well as prognostic end points.


RESULTS
Clinical variables selected and their weights included age (5), symptoms (2), diabetes (2), smoking (2), and estrogen status (1). ExECG variables selected and their weights included ST depression (2), exercise heart rate (4), and Duke Angina Index (3). For the validation group, score ranges are shown with the prevalence of CAD: <20 = 0/5 or 0%, 20-29 = 3/26 or 11%, 30-39 = 20/56 or 36%, 40-49 = 33/81 or 41%, 50-59 = 24/49 or 49%, 60-69 = 22/32 or 69%, and >70 = 7/7 or 100%. Frequency of death within 3 predetermined subgroups was as follows: low <40 = 3/1237 (0.2%), intermediate 40-60 = 9/383 (2.3%), high >60 = 4/54(7%); P<.0001.


CONCLUSIONS
A simple ExECG score was developed for use specifically in women. When evaluated in separate cohorts, the score stratified women with suspected coronary disease into groups with a gradually increasing frequency of coronary disease and death.
Morise
Anthony P
AP
Section of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WVa 26506, USA. amorise@pol.net
Lauer
Michael S
MS
Froelicher
Victor F
VF
D000328:Adult; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality; D005080:Exercise Test / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012015:Reference Standards; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors