title: Diagnostic accuracy of electrocardiographic ST-segment depression in patients with rapid atrial fibrillation for the prediction of coronary artery disease.
abstract: BACKGROUND
  We aimed to examine the diagnostic value of ST-segment depression in patients with rapid atrial fibrillation (AF) for the prediction of coronary artery disease (CAD).
  
  
  METHODS
  Hemodynamically stable patients with AF, and a heart rate > 80% of their maximum predicted according to their age, were allocated to 2 groups according to their electrocardiographic findings on admission: group A included patients without any ST-segment abnormalities and group B, patients with downward or horizontal ST-segment depression ≥ 1 mm in 2 or more contiguous leads. Group A patients were subjected to a dobutamine stress echo or Tl-201 myocardial single-photon emission computed tomography, followed by coronary angiography in case of abnormal results and Group B patients to coronary angiography. CAD was defined angiographically as stenosis of ≥ 50% in any major epicardial coronary vessel.
  
  
  RESULTS
  Out of 115 consecutive patients, with a mean age of 65.9 ± 10.2 years, 42.6% were male, 18.3% smokers, 68.7% hypertensive, 21.7% had diabetes, and 40% had hyperlipidemia. We enrolled 71 and 44 patients in group A and B, respectively. Prevalence of significant CAD among studied patients was 21.7%, 3/71 (4.2%) and 22/44 (50.0%) in group A and B, respectively. Overall ST-segment depression during rapid AF had 88.0% sensitivity (95% confidence interval [CI], 67.7%-96.8%) and 75.6% specificity (95% CI, 65.2%-83.7%) in predicting presence of CAD, and positive and negative predictive value was 50.0% (95% CI, 34.8%-65.2%) and 95.8% (95% CI, 87.3%-98.7%), respectively.
  
  
  CONCLUSIONS
  In consecutive patients with rapid AF, the absence of ST-segment depression might indicate absence of CAD.
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece. Electronic address: gregtsig@hotmail.com.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Tsigkas
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kopsida
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koutsogiannis
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Makris
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Theodoropoulos
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Kassimis
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Gkizas
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Hahalis
authors.affiliation: Cardiology Department, Patras University Hospital, Patras, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D054059:Coronary Occlusion / Q000175:diagnosis; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology; D015899:Tomography, Emission-Computed, Single-Photon