Identification of Severe Coronary Artery Disease Using Simple Clinical Parameters

Hubbard, Bradley; Gibbons, Raymond J.; Lapeyre, André C.; Zinsmeister, Alan R.; Clements, Ian P.

doi:10.1001/archinte.1992.00400140061014

Cited by 73 publications

(14 citation statements)

References 24 publications

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“…However, this test is considered less accurate in women compared with men. Reduced sensitivity has been attributed to lower prevalence of CAD and the inability of many women to exercise to maximum aerobic capacity [9,28,29]. Exercise ECG is generally considered also as less specific in women than in men even after correction for post-test referral bias [30].…”

Section: Discussionmentioning

confidence: 99%

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Greulich

Bruder

Parker

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundExercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed.Methods and resultsWe prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA.Exercise ECG, CMR and CA was completed in 68 females (age 66.4 ± 8.8 years, number of CAD risk factors 3.5 ± 1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was −3.0 ± 5.4 and was similar in those with and without CAD (−4.5 ± 5.8 and −2.4 ± 5.1; P = 0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P = 0.02, specificities 94% and 73%, P = 0.01, and accuracies 91% and 66%, P = 0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94 ± 0.03 vs 0.56 ± 0.07; P = 0.0001).ConclusionsIn women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.

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Section: Discussionmentioning

confidence: 99%

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Greulich

Bruder

Parker

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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“…The CS initially developed by Hubbard et al (9) paralleled efforts by Pryor et al (12), the Coronary Artery Surgery Study (CASS) (13) investigators, and others (14 -17) to develop a clinical model to predict disease severity and prognosis in patients with CAD. Hubbard et al (9) demonstrated that the probability of severe CAD increased as a function of the CS. This study utilizes the CS as a measure of pretest probability of severe CAD (and of adverse outcomes) in an overall low-risk population.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical score. Hubbard et al (9) developed the CS retrospectively in a population undergoing evaluation for CAD as a predictor of three-vessel or left main disease. A simple five-point scoring system was developed after consideration of 16 clinical and ECG variables.…”

Section: Methodsmentioning

confidence: 99%

“…The association between the CS and GSS and each of these end points, during the entire follow-up period, was evaluated by Cox proportional hazards analysis on both a univariate and bivariate (each variable adjusted for the other) basis. The GSS was selected prospectively as the single nuclear variable to be included in the analysis, based on previous studies (9,11). We tested the proportional hazards assumption by including the product of GSS with time and CS with time in the analysis.…”

Section: Methodsmentioning

confidence: 99%

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Utility of myocardial perfusion imaging in patients with low-risk treadmill scores

Poornima

Miller

Christian

et al. 2004

Journal of the American College of Cardiology

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“…Poornima et al (31) examined 1,461 patients with a low DTS and applied a clinical score developed by Hubbard et al (33). This clinical score was developed retrospectively in a patient cohort undergoing evaluation for CAD as a predictor of three-vessel or left main disease.…”

Section: See Pages 194 and 200mentioning

confidence: 99%

Risk stratification using stress myocardial perfusion imaging: don't neglect the value of clinical variables**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.

Watson¹

2004

Journal of the American College of Cardiology

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Identification of Severe Coronary Artery Disease Using Simple Clinical Parameters

Cited by 73 publications

References 24 publications

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Utility of myocardial perfusion imaging in patients with low-risk treadmill scores

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