Ryan T J, Fischer L D, Weiner D A, McCabe C H, Chaitman B, Kennedy J W, Ferguson J, Tristani F
Kardiologiia. 1982 Feb;22(2):22-6.
To determine to what extent the diagnostic accuracy of stress testing is influenced by the prevalence of coronary artery disease, we correlated the description of chest pain, the ST-segment response to exercise, and the results of coronary arteriography in 1465 men and 580 women from the registry for the Coronary Artery Surgery Study (CASS). A positive ST-segment response increased the pre-test risk by only 7 to 20%, whereas a negative ST-segment response decreased the risk by only 2 to 28%. Although the percentage of false positive results differed between men and women (12 +/- 1% vs 53 +/-- 3%, p less than 0.001), this difference was not seen in a subgroup matched for prevalence of coronary artery disease. Thus, the ability of stress testing to predict coronary artery disease is limited in a heterogenous population in which the prevalence of disease can be estimated through classification of chest pain and the sex of the patient. Additional multivariant linear discriminant function analysis on treadmill and angiographic data from 500 men with definite angina, 584 men with probable angina and 267 men with nonspecific chest pain identified independent predictors of presence and extent of coronary disease. The discriminant function developed clinical, and clinical and exercise risk indices for each patient subset. Probability curves demonstrated that exercise testing provided more diagnostic information than clinical data alone in patients with definite and probable angina. However, exercise testing in men with nonspecific chest pain was of limited value since disease prevalence was already low. We conclude that (a) analysis of the ST-segment response to exercise provides limited information regarding the diagnosis of coronary artery disease when used alone, and (b) use of other exercise variables in addition to clinical data improves the diagnostic ability of the exercise test in men with definite or probable angina.
为了确定冠状动脉疾病的患病率在多大程度上影响负荷试验的诊断准确性，我们将来自冠状动脉外科研究（CASS）登记处的1465名男性和580名女性的胸痛描述、运动时的ST段反应以及冠状动脉造影结果进行了关联分析。阳性ST段反应仅使预测试风险增加7%至20%，而阴性ST段反应仅使风险降低2%至28%。尽管男性和女性的假阳性结果百分比有所不同（12±1%对53±3%，p<0.001），但在冠状动脉疾病患病率匹配的亚组中未观察到这种差异。因此，在一个异质性人群中，负荷试验预测冠状动脉疾病的能力有限，在该人群中，可以通过胸痛分类和患者性别来估计疾病的患病率。对500名明确心绞痛男性、584名可能心绞痛男性和267名非特异性胸痛男性的跑步机和血管造影数据进行的额外多变量线性判别函数分析确定了冠状动脉疾病存在和程度的独立预测因素。判别函数为每个患者亚组制定了临床、临床和运动风险指数。概率曲线表明，运动试验在明确和可能心绞痛患者中比单独的临床数据提供了更多的诊断信息。然而，非特异性胸痛男性的运动试验价值有限，因为疾病患病率已经很低。我们得出结论：（a）单独使用运动时的ST段反应分析对于冠状动脉疾病的诊断提供的信息有限，（b）除临床数据外，使用其他运动变量可提高运动试验对明确或可能心绞痛男性的诊断能力。
