Gurunathan Sothinathan, Shanmuganathan Mayooran, Chopra Ankur, Pradhan Jiwan, Aboud Lily, Hampson Reinette, Yakupoglu Haci Yakup, Bioh Gabriel, Banfield Ann, Gage Heather, Khattar Raj, Senior Roxy
Department of Cardiology, Northwick Park Hospital, Harrow, UK.
Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Eur Heart J Open. 2023 May 22;3(3):oead053. doi: 10.1093/ehjopen/oead053. eCollection 2023 May.
There is a paucity of randomized diagnostic studies in women with suspected coronary artery disease (CAD). This study sought to assess the relative value of exercise stress echocardiography (ESE) compared with exercise electrocardiography (Ex-ECG) in women with CAD.
Accordingly, 416 women with no prior CAD and intermediate probability of CAD (mean pre-test probability 41%), were randomized to undergo either Ex-ECG or ESE. The primary endpoints were the positive predictive value (PPV) for the detection of significant CAD and downstream resource utilization. The PPV of ESE and Ex-ECG were 33% and 30% ( = 0.87), respectively for the detection of CAD. There were similar clinic visits (36 vs. 29, = 0.44) and emergency visits with chest pain (28 vs. 25, = 0.55) in the Ex-ECG and ESE arms, respectively. At 2.9 years, cardiac events were 6 Ex-ECG vs. 3 ESE, = 0.31. Although initial diagnosis costs were higher for ESE, more women underwent further CAD testing in the Ex-ECG arm compared to the ESE arm (37 vs. 17, = 0.003). Overall, there was higher downstream resource utilization (hospital attendances and investigations) in the Ex-ECG arm ( = 0.002). Using National Health Service tariffs 2020/21 (British pounds) the cumulative diagnostic costs were 7.4% lower for Ex-ECG compared with ESE, but this finding is sensitive to the cost differential between ESE and Ex-ECG.
In intermediate-risk women who are able to exercise, Ex-ECG had similar efficacy to an ESE strategy, with higher resource utilization whilst providing cost savings.
对于疑似冠心病（CAD）的女性患者，随机诊断研究较少。本研究旨在评估运动负荷超声心动图（ESE）与运动心电图（Ex-ECG）相比，在CAD女性患者中的相对价值。
因此，416例无既往CAD且CAD中度可能性（平均预测试概率41%）的女性被随机分配接受Ex-ECG或ESE检查。主要终点是检测显著CAD的阳性预测值（PPV）和下游资源利用情况。ESE和Ex-ECG检测CAD的PPV分别为33%和30%（P = 0.87）。Ex-ECG组和ESE组的门诊就诊次数（分别为36次对29次，P = 0.44）和胸痛急诊就诊次数（分别为28次对25次，P = 0.55）相似。在2.9年时，Ex-ECG组发生6例心脏事件，ESE组发生3例，P = 0.31。虽然ESE的初始诊断成本较高，但与ESE组相比，Ex-ECG组有更多女性接受了进一步的CAD检测（分别为37例对17例，P = 0.003）。总体而言，Ex-ECG组的下游资源利用（医院就诊和检查）更高（P = 0.002）。使用2020/21年英国国家医疗服务体系收费标准（英镑），Ex-ECG的累积诊断成本比ESE低7.4%，但这一发现对ESE和Ex-ECG之间的成本差异敏感。
在能够运动的中度风险女性中，Ex-ECG与ESE策略具有相似的疗效，资源利用率更高，同时节省成本。
