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Title
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Exercise electrocardiography for pre-test assessment of the likelihood of coronary artery disease
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Author
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Abstract
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| ObjectivesTo develop a tool including exercise electrocardiography (ExECG) for patient-specific clinical likelihood estimation of patients with suspected obstructive coronary artery disease (CAD). MethodsAn ExECG-weighted clinical likelihood (ExECG-CL) model was developed in a training cohort of patients with suspected obstructive CAD undergoing ExECG. Next, the ExECG-CL model was applied in a CAD validation cohort undergoing ExECG and clinically driven invasive coronary angiography and a prognosis validation cohort and compared with the risk factor-weighted clinical likelihood (RF-CL) model for obstructive CAD discrimination and prognostication, respectively.In the CAD validation cohort, obstructive CAD was defined as >50% diameter stenosis on invasive coronary angiography. For prognosis, the endpoint was non-fatal myocardial infarction and death. ResultsThe training cohort consisted of 1214 patients (mean age 57 years, 57% males). In the CAD (N=408; mean age 55 years, 53% males) and prognosis validation (N=3283; mean age 57 years, 57% males) cohorts, 11.8% patients had obstructive CAD and 4.4% met the endpoint. In the CAD validation cohort, discrimination of obstructive CAD was similar between the ExECG-CL and RF-CL models: area under the receiver-operating characteristic curves 83.1% (95% CIs 77.5% to 88.7%) versus 80.7% (95% CI 74.6% to 86.8%), p=0.14. In the ExECG-CL model, more patients had very low (& LE;5%) clinical likelihood of obstructive CAD compared with the RF-CL (42.2% vs 36.0%, p<0.01) where obstructive CAD prevalence and event risk remained low. ConclusionsExECG incorporated into a clinical likelihood model improves reclassification of patients to a very low clinical likelihood group with very low prevalence of obstructive CAD and favourable prognosis. |
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Language
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English
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Source (journal)
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Heart : official journal of the British Cardiac Society / British Cardiac Society; British Cardiovascular Society [London] - London, 1996, currens
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Publication
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London
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Bmj publishing group
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2024
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ISSN
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1355-6037
[print]
1468-201X
[online]
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DOI
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10.1136/HEARTJNL-2023-322970
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Volume/pages
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110
(2024)
, p. 263-270
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ISI
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001052660900001
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Pubmed ID
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37607813
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Full text (Publisher's DOI)
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Full text (open access)
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Full text (publisher's version - intranet only)
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