Exercise-induced ST depression and ST/heart rate index to predict triple-vessel or left main coronary disease: a multicenter analysis
M Bobbio,
R Detrano,
JJ Schmid,
A Janosi,
A Righetti,
M Pfisterer,
W Steinbrunn,
KH Guppy,
P Abi-Mansour,
JW Deckers,
et al.
Division of Cardiology, Veterans Affairs Medical Center, Long Beach, California.
The aim of this investigation was to determine the difference in accuracy between two frequently published noninvasive indicators of severity of coronary artery disease (exercise-induced ST segment depression and heart rate-adjusted ST depression [ST/HR index]). The study was designed as a survey of consecutive patients undergoing exercise electrocardiography and coronary angiography. There were a total of 2,270 patients without prior myocardial infarction or cardiac valvular disease referred for angiography from eight institutions in three countries; 401 of these patients had triple-vessel or left main coronary artery disease. The sensitivities of ST depression and ST/HR index in detecting triple-vessel or left main coronary artery disease were, respectively, 75% and 78% (p = 0.08) at cut point values where their specificities were equal (64%). This small increase in the accuracy of the ST/HR index was evident only at peak exercise heart rates below the median value of 132 beats/min, where the sensitivities of ST depression and ST/HR index were 73% and 76% (p = 0.03), respectively, at cut point values corresponding to a specificity of 60%. These results were consistent at all eight participating institutions. The increase in accuracy achieved by dividing exercise-induced ST depression by heart rate is small and confined exclusively to a low exercise heart rate. This lack of superiority cannot be generalized to all methods of heart rate adjustment.
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