title: [Implication of probability analysis for diagnosis of stable coronary diseases. Comparison of non-invasive diagnostic tests].
abstract: A prospective collection of clinical (history), electrocardiography (ECG), exercise electrocardiography (EE), dobutamine stress echocardiography (SE) and catheterization data was performed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. All patients (65% male) without prior history of myocardial infarction undergone clinical evaluation: chest pain classification according to Diamond, ECG, EE (regarded as positive on the basis of > or = 1 mm ST-depression), SE (ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model) and coronary angiography (CA):CAD was defined as > or = 50% narrowing of at least one major vessel. Sensitivity and specificity of ECG, EE, SE was calculated: and results are as follows respectively: 23% and 87%, 93% and 21%, 85% and 69%. On the basis of these results with implication of probability analysis two algorithms were developed by computer program. They incorporated pretest variables: age, gender, chest pain classification, ECG and results of one or two non-invasive tests: EE and (or) SE. The sensitivity and specificity of the algorithm is 96% and 44%.
  
  
  CONCLUSIONS
  1. Chest pain characteristics remains an effective tool for estimating probability of CAD. 2. The diagnostic value of resting electrocardiography in stable CAD is low. 3. SE has comparably sensitivity but significantly higher specificity than EE. 4. We demonstrated that when the likelihood of CAD is high on the basis of initial evaluation, diagnostic non-invasive testing is not indicated before CA. 5. When the probability is intermediate or low, implementation of first choice test should be different in women (SE) and men (EE).
authors.affiliation: Klinika Choroby Wieńcowej Instytutu Kardiologii w Warszawie.
authors.forename: Michał
authors.initials: M
authors.lastname: Lewandowski
authors.forename: Hanna
authors.initials: H
authors.lastname: Szwed
authors.forename: Ilona
authors.initials: I
authors.lastname: Kowalik
authors.forename: Anna
authors.initials: A
authors.lastname: Raczyńska
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kosmala
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Krzymińska-Stasiuk
authors.forename: Lech
authors.initials: L
authors.lastname: Paluszkiewicz
authors.forename: Krystian
authors.initials: K
authors.lastname: Wita
authors.forename: Jacek
authors.initials: J
authors.lastname: Flasiński
authors.forename: Grazyna
authors.initials: G
authors.lastname: Bednarczyk
authors.forename: Leszek
authors.initials: L
authors.lastname: Batalia
authors.forename: Marek
authors.initials: M
authors.lastname: Michalski
authors.forename: Jarosław
authors.initials: J
authors.lastname: Drozdz
authors.forename: Edyta
authors.initials: E
authors.lastname: Płońska
authors.forename: Andrzej
authors.initials: A
authors.lastname: Gackowski
authors.forename: Iwona
authors.initials: I
authors.lastname: Swiatkiewicz
authors.forename: Jacek
authors.initials: J
authors.lastname: Kazłowski
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000787:Angina Pectoris / Q000175:diagnosis*; D006328:Cardiac Catheterization / Q000379:methods; D025401:Echocardiography, Stress / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity