Bobbio M, Fubini A, Detrano R, Shandling A H, Ellestad M H, Clark J, Brezden O, Abecia A, Martinez-Caro D
Division of Cardiology, University of Torino, Italy.
J Clin Epidemiol. 1994 Apr;47(4):389-95. doi: 10.1016/0895-4356(94)90160-0.
Patients' demographic and clinical characteristics may affect diagnostic accuracy of cardiologists. We asked a group of experienced cardiologists from three institutions to estimate the pretest probability of coronary artery disease in 257 patients referred for diagnostic coronary angiography and with no history of previous myocardial infarction nor valvular heart disease. Physicians pretest estimates were compared with the diagnostic findings of coronary angiography. We tested the influence of five variables on the accuracy of the pretest estimates: age, sex, chest pain characteristics, rest electrocardiogram and electrocardiographic exercise test result. Cardiologists tended to overestimate the presence of coronary artery disease and this tendency was particularly remarkable in the group of patients showing a negative exercise test. Pretest diagnostic accuracy was 0.72 when the test result was negative and 0.85 when the test result was positive (95% confidence interval of the difference 0.03 to 0.23; p < 0.001). The diagnosis of coronary artery disease was also more accurate for male than for female patients (0.81 vs 0.70; 95% confidence interval of the difference 0.02 to 0.21; p < 0.02). Characteristics of chest pain, age and rest electrocardiogram did not affect the level of pretest diagnostic accuracy. Cardiologists should be cognizant of correctly interpreting a negative exercise test and the clinical data of female patients; in both cases, they should move circumspect of the diagnosis of coronary artery disease.
患者的人口统计学和临床特征可能会影响心脏病专家的诊断准确性。我们邀请了来自三家机构的一组经验丰富的心脏病专家，对257例因诊断性冠状动脉造影而转诊且无既往心肌梗死病史或瓣膜性心脏病史的患者的冠状动脉疾病预测试概率进行评估。将医生的预测试估计值与冠状动脉造影的诊断结果进行比较。我们测试了五个变量对预测试估计准确性的影响：年龄、性别、胸痛特征、静息心电图和心电图运动试验结果。心脏病专家往往高估冠状动脉疾病的存在，这种倾向在运动试验结果为阴性的患者组中尤为明显。当试验结果为阴性时，预测试诊断准确性为0.72，当试验结果为阳性时为0.85（差异的95%置信区间为0.03至0.23；p<0.001）。冠状动脉疾病的诊断对男性患者也比对女性患者更准确（0.81对0.70；差异的95%置信区间为0.02至0.21；p<0.02）。胸痛特征、年龄和静息心电图不影响预测试诊断准确性水平。心脏病专家应认识到正确解读运动试验阴性结果以及女性患者的临床数据；在这两种情况下，他们对冠状动脉疾病的诊断都应谨慎。
