Jeetley Paramjit, Burden Leah, Senior Roxy
Department of Cardiovascular Medicine, Northwick Park Hospital and Institute for Medical Research, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
Eur J Echocardiogr. 2006 Mar;7(2):155-64. doi: 10.1016/j.euje.2005.05.002. Epub 2005 Jun 20.
To compare exercise electrocardiography (ExECG) and stress echocardiography (SE) in the risk stratification of patients presenting to hospital with cardiac-sounding chest pain, non-diagnostic ECGs and negative cardiac Troponin.
Patients presenting with acute chest pain were prospectively randomised to early ExECG or SE. A post-test likelihood of CAD was determined by the pre-test likelihood and the result of the stress test. Patients with a low post-test likelihood of CAD were discharged; those with a high post-test probability were considered for coronary angiography. All others were managed according to standard hospital protocols.
A total of 302 patients underwent either ExECG or SE. SE identified significantly more patients with a low post-test probability of CAD (80% vs 31%, p<0.0001) and significantly fewer patients with an intermediate post-test likelihood of CAD compared to ExECG (3% vs 47%; p<0.0001). Significantly fewer patients undergoing SE were referred for further tests to exclude or refute the diagnosis of CAD (16% vs 52%; p<0.0001). In total, 36 (12%) had flow limiting CAD demonstrated by coronary angiography. Significant CAD was seen in fewer patients with a positive ExECG than with a positive SE (56% vs 84% (p=0.12)). Event rates were low for both modalities in patients with low post-test probability (3.5% for SE vs 5.1% for ExECG; p=ns) though the number of patients identified as low risk was higher if SE was performed.
Despite negative cardiac Troponin, 12% of patients with acute chest pain had significant CAD. SE is superior to ExECG in discriminating between those patients with a low and intermediate risk of CAD and correctly identified patients with significant CAD, as well as conferring an excellent prognosis in those considered low risk. SE significantly reduces the requirement for further tests to diagnose CAD compared to ExECG.
比较运动心电图（ExECG）和负荷超声心动图（SE）在因疑似心脏病胸痛入院、心电图无诊断意义且心肌肌钙蛋白阴性患者的风险分层中的作用。
将出现急性胸痛的患者前瞻性随机分为早期进行ExECG或SE检查。通过检查前可能性和负荷试验结果确定CAD的检查后可能性。CAD检查后可能性低的患者出院；可能性高的患者考虑进行冠状动脉造影。所有其他患者按照标准医院方案处理。
共有302例患者接受了ExECG或SE检查。与ExECG相比，SE识别出CAD检查后可能性低的患者明显更多（80%对31%，p<0.0001），而CAD检查后可能性中等的患者明显更少（3%对47%；p<0.0001）。接受SE检查的患者中被转诊进行进一步检查以排除或否定CAD诊断的明显更少（16%对52%；p<0.0001）。共有36例（12%）通过冠状动脉造影显示存在血流限制性CAD。ExECG阳性的患者中显著CAD的发生率低于SE阳性的患者（56%对84%（p=0.12））。在检查后可能性低的患者中，两种检查方式的事件发生率都较低（SE为3.5%，ExECG为5.1%；p无显著性差异），不过如果进行SE检查，识别出的低风险患者数量更多。
尽管心肌肌钙蛋白阴性，但12%的急性胸痛患者存在显著CAD。在区分CAD低风险和中等风险患者以及正确识别显著CAD患者方面，SE优于ExECG，并且在那些被认为低风险的患者中预后良好。与ExECG相比，SE显著减少了诊断CAD所需的进一步检查。
