Morise Anthony P, Lauer Michael S, Froelicher Victor F
Section of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WVa 26506, USA.
Am Heart J. 2002 Nov;144(5):818-25. doi: 10.1067/mhj.2002.125835.
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).
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.
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.
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.
最近修订的美国心脏病学会/美国心脏协会运动心电图（ExECG）指南建议，使用ExECG评分来辅助疑似冠状动脉疾病（CAD）患者的管理决策。
我们对442名接受了ExECG和冠状动脉造影检查的女性进行研究（CAD为≥1处病变且狭窄≥50%；CAD患病率为32%），以得出一个包括临床和ExECG变量的ExECG评分。通过逻辑回归分析，选择变量并确定相对权重。将变量代码乘以各自的权重后求和，得出最终的ExECG评分。该评分在关于血管造影以及预后终点的不同人群中进行了验证。
选择的临床变量及其权重包括年龄（5）、症状（2）、糖尿病（2）、吸烟（2）和雌激素状态（1）。选择的ExECG变量及其权重包括ST段压低（2）、运动心率（4）和杜克心绞痛指数（3）。对于验证组，显示了CAD患病率对应的评分范围：<20 = 0/5或0%，20 - 29 = 3/26或11%，30 - 39 = 20/56或36%，40 - 49 = 33/81或41%，50 - 59 = 24/49或49%，60 - 69 = 22/32或69%，>70 = 7/7或100%。在3个预定亚组内的死亡频率如下：低<40 = 3/1237（0.2%），中40 - 60 = 9/383（2.3%），高>60 = 4/54（7%）；P<0.0001。
开发了一种专门用于女性的简单ExECG评分。在不同队列中进行评估时，该评分将疑似冠心病的女性分层为冠心病和死亡频率逐渐增加的组。
