Evaluation of pretest and exercise test scores to assess all-cause mortality in unselected patients presenting for exercise testing with symptoms of suspected coronary artery disease.
OBJECTIVE
To determine how well recently developed multivariables scores assess for all-cause mortality in patients with suspected coronary disease presenting for exercise electrocardiography (ExECG).


BACKGROUND
Recently revised American College of Cardiology/American Heart Association guidelines for ExECG have suggested that ExECG scores be used to assist in management decisions in patients with suspected coronary artery disease. Recently developed scores accurately stratify patients according to angiographic disease severity.


METHODS
To determine how well these scores assess for all-cause mortality, we utilized 4,640 patients without known coronary disease who underwent ExECG to evaluate symptoms of suspected coronary disease between 1995 and 2001. Previously validated pretest and exercise test scores as well as the Duke treadmill score were applied to each patient. All-cause mortality was our end point.


RESULTS
Overall mortality was 3.0% with 2.8 +/- 1.6 years of follow-up. All three scores stratified patients into low-, intermediate-, and high-risk groups (p < 0.00001). No differences were seen when patients were evaluated as subgroups according to gender, diabetes, beta-blockers, or inpatient status. Low-risk patients defined by the Duke treadmill score had consistently higher mortality and absolute number of deaths compared with low-risk patients using other scores. In addition, the Duke treadmill score had less incremental stratifying value than the new exercise score.


CONCLUSIONS
Simple pretest and exercise scores risk-stratified patients with suspected coronary disease in accordance with published guidelines and better than the Duke treadmill score. These results extend to diabetics, inpatients, women, and patients on beta-blockers.
Morise
Anthony P
AP
Section of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA. amorise@pol.net
Jalisi
Farrukh
F
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002423:Cause of Death; D017023:Coronary Angiography / Q000592:standards; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D048909:Diabetes Complications; D004452:Echocardiography / Q000592:standards; D004562:Electrocardiography / Q000379:methods / Q000592:standards*; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016019:Survival Analysis
D000319:Adrenergic beta-Antagonists