Doubilet P, McNeil B J, Weinstein M C
Med Decis Making. 1985 Fall;5(3):293-309. doi: 10.1177/0272989X8500500305.
We examined the decision whether to perform coronary angiography (followed by bypass surgery if appropriate findings are present) in middle-aged men who have chest pain and have undergone exercise tolerance testing (ETT). We developed a model of this decision that combines data from a variety of sources and selects the optimal strategy based on health outcome and, if desired, monetary cost. The analysis supports the following conclusions: for patients with nonspecific chest pain or atypical angina, the ETT provides useful information concerning the decision; furthermore, the number of millimeters of ST-segment depression above which angiography should be performed depends on coronary risk factors and pain severity. A normal ETT is insufficient evidence to exclude coronary angiography for patients with typical angina, provided that one is willing to expand resources for health benefits at levels comparable to those for other accepted medical practices. If monetary considerations are excluded, the preceding statement concerning ETT and angiography also holds for patients with atypical angina and for those with nonspecific pain and advanced risk factors. These last two conclusions suggest that ETT is not useful in guiding management decisions concerning coronary angiography in patients at high enough risk of coronary artery disease on the basis of symptoms and risk profile.
我们研究了对于有胸痛且已进行运动耐量测试（ETT）的中年男性，是否进行冠状动脉造影（若有合适结果则随后进行搭桥手术）的决策。我们建立了一个关于此决策的模型，该模型整合了来自各种来源的数据，并根据健康结果以及（如有需要）货币成本来选择最优策略。分析支持以下结论：对于非特异性胸痛或不典型心绞痛患者，ETT为决策提供了有用信息；此外，应当进行血管造影的ST段压低毫米数取决于冠状动脉危险因素和疼痛严重程度。对于典型心绞痛患者，正常的ETT不足以作为排除冠状动脉造影的证据，前提是愿意为健康益处投入与其他公认医疗实践相当水平的资源。如果不考虑货币因素，上述关于ETT和血管造影的陈述对于不典型心绞痛患者以及有非特异性疼痛和高危因素的患者同样适用。最后这两个结论表明，基于症状和风险概况，对于冠状动脉疾病风险足够高的患者，ETT在指导冠状动脉造影管理决策方面并无用处。
