Alvi Raza, Sklyar Eduard, Gorski Robert, Atoui Moustapha, Afshar Maryam, Bella Jonathan N
Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY.
Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY Icahn School of Medicine at Mount Sinai, New York, NY
J Am Heart Assoc. 2016 Jun 10;5(6):e002832. doi: 10.1161/JAHA.115.002832.
The diagnostic value of the Athens QRS score to detect obstructive coronary artery disease CAD in patients with otherwise normal exercise stress test remains unclear.
We analyzed 458 patients who underwent exercise stress test with or without myocardial perfusion imaging within 2 months of coronary angiography from 2008 to 2011. Patients (n=173) with abnormal stress test based on ST segment criteria were excluded. The Athens QRS score ≤5 was defined as abnormal. In our study cohort, 285 patients met the inclusion criteria and were divided into 2 groups: low Athens QRS score (LQRS, n=56), with QRS score ≤5 and normal Athens QRS score normal Athens QRS score, n=229), with QRS score >5. The presence of single-vessel and multivessel obstructive CAD was higher in LQRS than in normal Athens QRS score patients (47% versus 7.5% and 30% versus 3.8%, respectively, all P<0.001). Logistic regression analysis showed that the likelihood of CAD was strongly and independently associated with LQRS (odds ratio=36.81, 95% CI: 10.77-120.47), diabetes (odds ratio=6.49, 95% CI: 2.41-17.49), lower maximum heart rate (odds ratio=0.92, 95% CI: 0.88-0.95, all P<0.001), and older age (odds ratio=1.93, CI: 1.88-1.97, P=0.002).
In a clinical cohort of patients with chest pain and normal exercise stress test, LQRS score is a strong independent predictor of presence of CAD. LQRS patients have a 6-fold higher prevalence of CAD and may warrant further evaluation even with reassuring exercise stress test.
对于运动负荷试验结果正常的患者，雅典QRS评分检测阻塞性冠状动脉疾病（CAD）的诊断价值尚不清楚。
我们分析了2008年至2011年间在冠状动脉造影检查前2个月内接受运动负荷试验（无论是否进行心肌灌注成像）的458例患者。根据ST段标准，排除运动负荷试验异常的患者（n = 173）。将雅典QRS评分≤5定义为异常。在我们的研究队列中，285例患者符合纳入标准，并分为两组：低雅典QRS评分（LQRS，n = 56），QRS评分≤5；正常雅典QRS评分（正常雅典QRS评分，n = 229），QRS评分>5。LQRS组单支血管和多支血管阻塞性CAD的发生率高于正常雅典QRS评分组（分别为47%对7.5%和30%对3.8%，P均<0.001）。逻辑回归分析显示，CAD的可能性与LQRS密切且独立相关（比值比=36.81，95%可信区间：10.77 - 120.47）、糖尿病（比值比=6.49，95%可信区间：2.41 - 17.49）、较低的最大心率（比值比=0.92，95%可信区间：0.88 - 0.95，P均<0.001）以及年龄较大（比值比=1.93，可信区间：1.88 - 1.97，P = 0.002）。
在胸痛且运动负荷试验正常的临床队列中，LQRS评分是CAD存在的有力独立预测指标。LQRS组患者CAD患病率高6倍，即使运动负荷试验结果令人放心，也可能需要进一步评估。
