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September 29, 1977New England Journal of Medicine

The predictive value of exercise-induced ST-segment depression for detecting coronary-artery disease depends on the degree of depression and pretest risk, representing a continuum of risk.

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Why the study?

Does applying Bayes's theorem to half-millimeter ranges of ST-segment depression improve the diagnostic interpretation of exercise stress testing for coronary artery disease?

Population

Patients undergoing exercise stress testing for suspected coronary-artery disease

Design

Other

Key result

The predictive value of exercise-induced ST-segment depression for detecting coronary-artery disease depends on the degree of depression and pretest risk, representing a continuum of risk.

Authors

RRRobert D. RifkinWHWilliam B. Hood

Discussion

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Overview

Supports graded ST-depression interpretation by pretest probability in exercise testing; leaves open prospective outcome validation of refined thresholds.

Key Points

  • This research aims to assess how exercise-induced ST-segment depression indicates coronary-artery disease using Bayesian analysis.
  • Evaluated ST-segment depression in exercise stress testing data using likelihood-ratio formulation of Bayes's theorem.
  • Partitioned results into half-millimeter ranges of ST-segment depression for analysis.
  • Computed predictive values reflecting the correlation between test results and pretest risk of coronary-artery disease.
  • Predictive value of stress tests varies significantly with the degree of ST-segment depression.
  • Pretest risk of coronary-artery disease significantly impacts the predictive value, suggesting a continuum of risk rather than binary results.
  • The traditional interpretation of test results as 'positive' or 'negative' is deemed inappropriate.

Study Design

Type

Observational

Structured PICO

Does applying Bayes's theorem to half-millimeter ranges of ST-segment depression improve the diagnostic interpretation of exercise stress testing for coronary artery disease?

P
Population
Patients undergoing exercise stress testing for suspected coronary-artery disease
I
Intervention
Interpretation of exercise-induced ST-segment depression using Bayes's theorem partitioned into half-millimeter ranges
O
Outcome
Diagnostic accuracy and predictive value of exercise-induced ST-segment depression in detecting coronary-artery disease

Exercise stress test results should be interpreted as a continuum of risk based on the extent of ST-segment depression and pretest probability, rather than simply as binary 'positive' or 'negative' results.

Cite This Study

Rifkin et al. (1977) conducted an observational in coronary-artery disease. Electrocardiographic Exercise Stress Testing was evaluated on diagnostic accuracy of exercise-induced ST-segment depression. The predictive value of exercise-induced ST-segment depression for detecting coronary-artery disease depends on the degree of depression and pretest risk, representing a continuum of risk.

synapsesocial.com/papers/6a0f236704e2b0ba896c9705https://doi.org/10.1056/nejm197709292971301
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