A Consensus Approach to Diagnosing Coronary Artery Disease Based on Clinical and Exercise Test Data

Do, Duc; West, Jeffrey A.; Atwood, Eddie; Froelicher, Victor; Morise, Anthony P.

doi:10.1378/chest.111.6.1742

Cited by 42 publications

(21 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More recently, a VA score (see appendix 3) was generated by a similar method in over 700 men from two institutions. 8 The VA score diagnosed CAD more accurately than the standard ST response criteria and with an accuracy similar to that of the Detrano and Morise scores. The ACC/AHA guidelines on exercise testing suggest using treadmill scores to enhance the diagnostic characteristics of the exercise treadmill test.…”

Section: Introductionmentioning

confidence: 61%

“…2,3 Several treadmill scores, which incorporate both clinical and test variables, have been proposed as useful tools in this regard. [4][5][6][7][8] The Duke Treadmill Score (DTS), traditionally a prognostic score, was recently tested as a diagnostic score and shown to predict CAD better than the ST response alone. 9 The American College of Cardiology/American Heart Association (ACC/AHA) guidelines on exercise testing suggest using computer-assisted treadmill scores to enhance the interpretation of the test.…”

Section: Introductionmentioning

confidence: 99%

“…20 With the advent of the computer age, several probabili-119 ty scores, created with multiple logistic regression analysis, have been described. [4][5][6][7][8] Detrano et al analyzed exercise data in over 3,000 patients from eight institutions and identified significant clinical and test characteristics which were applied to a computer algorithm (Detrano score, see appendix 1) for estimating the probability of any significant coronary obstruction. 6 In a test population of almost 400 patients from three institutions, this group found that the Detrano score was at least as accurate for diagnosing CAD as expert cardiac clinicians familiar with the clinical and exercise test data of the patients.…”

Section: Introductionmentioning

confidence: 99%

“…To overcome this drawback, Froelicher and others have suggested using consensus scores; by incorporating a number of treadmill scores, a consensus score can overcome deficiencies that one score alone may have in a particular population, and therefore can provide accurate diagnosis of CAD in a broad range of patients. 8 To test this hypothesis, we included a Consensus score in our analysis.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A comparison of treadmill scores to diagnose coronary artery disease

Fearon

Gauri

Myers

et al. 2002

Clinical Cardiology

View full text Add to dashboard Cite

SummaryBackground: Recently, several treadmill scores have been proposed as means for improving the diagnostic accuracy of the exercise treadmill test (ETT). Questions remain regarding the diagnostic accuracy of treadmill scores when applied to a different patient population than that from which they were derived; furthermore, many treadmill scores have not been compared with one another in the same population.Hypothesis: The diagnostic accuracy of treadmill scores may not be the same.Methods: A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. All patients underwent a standard ETT followed by coronary angiography. Using angiographic evidence of coronary artery disease (CAD) as a reference, the area under the curve (AUC) of receiver operator characteristic (ROC) plots of the ST response alone, the Duke Treadmill Score (DTS), the Morise score, the Detrano score, the VA score, and a Consensus score consisting of the Morise, Detrano, and VA scores together were calculated and compared. The predictive accuracies of the DTS and the Consensus score to stratify patients for the likelihood of CAD were calculated and compared.Results: In all, 1,282 patients without a prior myocardial infarction had an ETT and coronary angiography. The AUC (± standard error) was 0.67 ± 0.01 for the ST response, 0.73 ±

show abstract

Section: Introductionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A comparison of treadmill scores to diagnose coronary artery disease

Fearon

Gauri

Myers

et al. 2002

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…However, the use of treadmill scores can increase the predictive accuracy of the test to be comparable to exercise echocardiography and nuclear perfusion. 32 …”

Section: Study Limitationsmentioning

confidence: 99%

Clinical Utility of the Exercise ECG in Patients With Diabetes and Chest Pain

Lee

Fearon

Froelicher³

2001

Chest

View full text Add to dashboard Cite

Objective: The purpose of this study was to determine the characteristics of exercise treadmill testing in diabetic patients presenting with chest pain. Background: The diagnosis of coronary artery disease (CAD) in diabetic patients is confounded by different manifestations of coronary disease than are seen in the general population. Because of the association of diabetes with accelerated CAD, it is critical to assess the diagnostic utility of the standard exercise test in diabetic patients with chest pain. Methods: This study was a retrospective analysis of standard exercise test results in 1,282 male patients without prior myocardial infarction who had undergone coronary angiography and were being evaluated for possible CAD at two Veterans' Administration institutions. Results: In patients with diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 69%; the sensitivity of the exercise test was 47% (95% confidence interval [CI], 41 to 58), and specificity was 81% (95% CI, 68 to 89). In patients without diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 58%; the sensitivity of the exercise test was 52% (95% CI, 48 to 56), and specificity was 80% (95% CI, 76 to 83). The receiver operating characteristic curves were also similar in both diabetic and nondiabetic patients (0.67 and 0.68, respectively).Conclusion: These data demonstrate that the standard exercise test has similar diagnostic characteristics in diabetic as in nondiabetic patients.(CHEST 2001; 119:1576 -1581)

show abstract