Morise Anthony P, Olson Marian B, Merz C Noel Bairey, Mankad Sunil, Rogers William J, Pepine Carl J, Reis Steven E, Sharaf Barry L, Sopko George, Smith Karen, Pohost Gerald M, Shaw Leslee
Section of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WVa, USA.
Am Heart J. 2004 Jun;147(6):1085-92. doi: 10.1016/j.ahj.2003.12.034.
Recently revised American College of Cardiology/American Heart Association guidelines have suggested that exercise test scores be used in decisions concerning patients with suspected coronary artery disease (CAD). Pretest and exercise test scores derived for use in women without known CAD have not been tested in women with a low prevalence of CAD.
Within the Women's Ischemia Syndrome Evaluation (WISE) study, we evaluated 563 women undergoing coronary angiography for suspected myocardial ischemia. The prevalence of angiographic CAD was 26%. Overall, 189 women underwent treadmill exercise testing. Prognostic end points included death, myocardial infarction, stroke, and revascularization.
Each score stratified women into 3 probability groups (P <.001) according to the prevalence of coronary disease: Pretest: low 20/164 (12%), intermediate 53/245 (22%), high 75/154 (49%); Exercise test: low 11/83 (13%), intermediate 22/74 (30%), high 17/32 (53%). However, the Duke score did not stratify as well: low 7/46 (15%), intermediate 36/126 (29%), high 6/17 (35%); P =.44. When pretest and exercise scores were considered together, the best stratification with the exercise test score was in the intermediate pretest group (P <.03). The Duke score did not stratify this group at all (P =.98). Pretest and exercise test scores also stratified women according to prognostic end points: pretest--low 7/164 (4.3%), intermediate 28/245 (11.4%), high 27/154 (17.5%), P <.01; exercise test--low 4/83 (4.8%) and intermediate-high 17/106 (16%), P =.014.
Both pretest and exercise test scores performed better than the Duke score in stratifying women with a low prevalence of angiographic CAD. The exercise test score appears useful in women with an intermediate pretest score, consistent with American College of Cardiology/American Heart Association guidelines.
最近修订的美国心脏病学会/美国心脏协会指南建议，运动试验评分可用于指导疑似冠心病（CAD）患者的决策。用于无已知CAD女性的预测试和运动试验评分尚未在CAD患病率较低的女性中进行验证。
在女性缺血综合征评估（WISE）研究中，我们评估了563名因疑似心肌缺血接受冠状动脉造影的女性。血管造影显示CAD的患病率为26%。总体而言，189名女性接受了平板运动试验。预后终点包括死亡、心肌梗死、中风和血运重建。
根据冠心病患病率，每种评分将女性分为3个概率组（P<.001）：预测试：低风险20/164（12%），中风险53/245（22%），高风险75/154（49%）；运动试验：低风险11/83（13%），中风险22/74（30%），高风险17/32（53%）。然而，杜克评分的分层效果不佳：低风险7/46（15%），中风险36/126（29%），高风险6/17（35%）；P = 0.44。当综合考虑预测试和运动评分时，运动试验评分在预测试中风险组的分层效果最佳（P<.03）。杜克评分在该组中完全没有分层效果（P = 0.98）。预测试和运动试验评分还根据预后终点对女性进行了分层：预测试——低风险7/164（4.3%），中风险28/245（11.4%），高风险27/154（17.5%），P<.01；运动试验——低风险4/83（4.8%），中高风险17/106（16%），P = 0.014。
在对血管造影显示CAD患病率较低的女性进行分层时，预测试和运动试验评分均比杜克评分表现更好。运动试验评分在预测试评分为中等的女性中似乎有用，这与美国心脏病学会/美国心脏协会指南一致。
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