[Angiographic evaluation of high-risk treadmill scores in patients with unstable angina according to sex, age, or use of drugs with a negative chronotropic effect].
OBJECTIVE
The aim of the study is to determine whether age, sex, or the use of drugs with a negative chronotropic effect modifies the sensitivity, specificity, positive or negative predictive value, or positive or negative likelihood ratio of the high-risk criteria used in exercise testing as defined by the Spanish Society of Cardiology (SEC) and the American College of Cardiology/American Heart Association (ACC/AHA), the Duke treadmill score, the Veterans Affairs and West Virginia prognostic score, or the ST/Heart Rate Index at the time when left main coronary artery disease, three-vessel disease or two-vessel disease involving the proximal left anterior descending artery is detected by coronary angiography.


METHODS
The study included a cohort of 469 consecutive patients aged 75 years who were admitted to hospital for unstable angina. All patients underwent exercise stress testing and coronary angiography.


RESULTS
In all situations, the ACC/AHA high-risk criteria had the highest sensitivity, negative predictive value, and negative likelihood ratio, and the Duke Treadmill Score had the highest specificity and positive predictive value. The diagnostic accuracy of the other treadmill scores was affected by sex, age or the use of drugs with a negative chronotropic effect.


CONCLUSIONS
The ACC/AHA high-risk criteria and Duke Treadmill Score provided useful additional information during the assessment of ST-segment depression. These measures could help improve the diagnostic accuracy of conventional ECG exercise testing in women, older individuals, and patients taking beta-blockers or non-dihydropyridine calcium antagonists.
Alvarez-Tamargo
José A
JA
Unidad de Cardiología, Hospital Carmen y Severo Ochoa, Sienra 11, 33800 Cangas del Narcea, Asturias, Spain. joseantonio.alvarezt@sespa.princast.es
Simarro Martín-Ambrosio
Eugenio
E
Romero-Tarín
Enrique
E
Albadalejo-Salinas
Vicente J
VJ
de la Hera
Jesús M
JM
Martín-Fernández
María
M
Aguado
Marcos G
MG
Barriales-Alvarez
Vicente
V
de la Tassa
Cesar Morís
CM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012737:Sex Factors
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers