Bobbio M, Pollock B H, Cohen I, Diamond G A
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
Am J Cardiol. 1988 Nov 1;62(13):896-900. doi: 10.1016/0002-9149(88)90889-2.
The discriminant accuracy of 14 variables derived from clinical evaluation, cardiac fluoroscopy, exercise electrocardiography, thallium scintigraphy and radionuclide angiography was assessed with respect to the diagnosis of angiographic coronary artery disease (CAD) among 607 patients undergoing coronary angiography, and with respect to the prognosis of subsequent cardiac death or nonfatal infarction among 4,104 patients followed for 1 year after testing. Discriminant accuracy (quantified in terms of the area under a receiver-operating characteristic curve for each variable) ranged from 50 to 73% for diagnosis, and from 54 to 77% for prognosis. Although there was a great deal of variability from test to test, variables representing direct or indirect manifestations of myocardial ischemia tended to correlate better with prognosis. Thus, variables derived from radionuclide angiography and thallium scintigraphy tended to have more prognostic accuracy than diagnostic accuracy, while fluoroscopy tended to have more diagnostic accuracy than prognostic accuracy. The pattern associated with clinical evaluation and exercise electrocardiography was less discernable. Accordingly, the accuracy of noninvasive tests with respect to diagnosis and prognosis of CAD should be separately determined based on individual empiric observation.
在607例接受冠状动脉造影的患者中，评估了来自临床评估、心脏荧光透视检查、运动心电图、铊闪烁扫描和放射性核素血管造影的14个变量对血管造影冠状动脉疾病（CAD）诊断的判别准确性；并在4104例检测后随访1年的患者中，评估了这些变量对后续心源性死亡或非致死性梗死预后的判别准确性。判别准确性（以每个变量的受试者操作特征曲线下面积量化）在诊断方面为50%至73%，在预后方面为54%至77%。尽管不同检测之间存在很大差异，但代表心肌缺血直接或间接表现的变量往往与预后相关性更好。因此，来自放射性核素血管造影和铊闪烁扫描的变量在预后方面的准确性往往高于诊断方面，而荧光透视检查在诊断方面的准确性往往高于预后方面。与临床评估和运动心电图相关的模式则较难辨别。因此，应基于个体经验观察分别确定非侵入性检测对CAD诊断和预后的准确性。
