Ramsdale D R, Faragher E B, Bennett D H, Bray C L, Ward C, Beton D C
Br Med J (Clin Res Ed). 1982 Jan 23;284(6311):223-6. doi: 10.1136/bmj.284.6311.223.
A prognostic index for predicting significant coronary artery disease was established using multiple logistic regression analysis of clinical data from 643 patients with valvular heart disease who had undergone routine coronary arteriography before valve replacement. The index or equation obtained incorporated the presence of angina, a family history of ischaemic heart disease, age, cigarette smoking habits, mitral valve disease, sex, and electrocardiographic evidence of myocardial infarction. The equation was validated using prospective data from 387 patients with valvular disease and shown to enable almost a third of routine coronary arteriograms to be omitted while maintaining 95% sensitivity for patients with coronary artery disease. Similar analysis of the more detailed prospective data produced a second discriminant function incorporating diastolic blood pressure, total cigarettes smoked in life, the severity of angina, family history of ischaemic heart disease, age, current cigarette smoking habits, and the ratio of total to high density lipoprotein cholesterol. This method improved the discrimination between patients with and without coronary artery disease, allowing omission of 30% of routine coronary arteriograms with 100% sensitivity for patients with coronary disease and omission of 41% with a 96% sensitivity level.
通过对643例瓣膜性心脏病患者的临床资料进行多因素逻辑回归分析，建立了预测严重冠状动脉疾病的预后指数。这些患者在瓣膜置换术前均接受了常规冠状动脉造影。所得指数或方程纳入了心绞痛、缺血性心脏病家族史、年龄、吸烟习惯、二尖瓣疾病、性别以及心肌梗死的心电图证据。该方程使用387例瓣膜病患者的前瞻性数据进行验证，结果表明，在保持对冠心病患者95%敏感性的同时，可省略近三分之一的常规冠状动脉造影。对更详细的前瞻性数据进行类似分析，得出了第二个判别函数，该函数纳入了舒张压、终生吸烟总量、心绞痛严重程度、缺血性心脏病家族史、年龄、当前吸烟习惯以及总胆固醇与高密度脂蛋白胆固醇的比值。该方法提高了对有无冠状动脉疾病患者的鉴别能力，可省略30%的常规冠状动脉造影，对冠心病患者的敏感性为100%；省略41%时，敏感性水平为96%。
