Key result
A positive exercise treadmill test independently predicted the presence of CAD in Korean women (OR 3.276; 95% CI 1.643-6.532; p=0.001), whereas pretest probability showed marginal predictability.
Why the study?
Do pretest probability and exercise treadmill testing accurately predict the presence of coronary artery disease in Korean women?
Cross-Sectional (n=335)
Do pretest probability and exercise treadmill testing accurately predict the presence of coronary artery disease in Korean women?
In Korean women with suspected CAD, standard pretest probability and exercise treadmill testing have limited predictive value and lower sensitivity than previously reported, though the high negative predictive value of ETT may help avoid unnecessary invasive testing.
Positive ETT was associated with CAD; leaves open whether ETT or PTP should guide testing in Korean women.
BACKGROUND: Pretest probability (PTP) and an exercise treadmill test (ETT) are recommended for the initial evaluation of possible coronary artery disease (CAD), but the applicability of these tests in Korean women has not been evaluated. METHODS: Korean women with PTP, ETT, and invasive coronary angiography results were enrolled. Across all PTP levels, PTP and ETT statistics were evaluated and independent CAD predictors obtained. RESULTS: Of the 335 patients (mean age 58.0 ± 10.2 years), 99 and 236 were in the low (LPTP) and intermediate PTP (IPTP) groups, respectively. The observed prevalence of CAD was significantly lower than the PTP. (7.1% vs. 9.1 ± 4.9% in LPTP, p < 0.001; 23.3% vs. 33.0 ± 15.1% in IPTP, p < 0.001) The ETT's sensitivity and positive predictive values (PPVs) appeared lower than previously reported (LPTP: 42.9% and 16.7%; IPTP: 61.8% and 37.0%), whereas the negative predictive values (NPVs) were higher (LPTP: 95.1%; IPTP: 85.4%). After multivariate adjustments, positive ETT (odds ratio 3.276, 95% confidence interval 1.643-6.532, p = 0.001) independently predicted the presence of CAD, but the PTP showed only marginal predictability (odds ratio 1.019, 95% confidence interval 0.998-1.041, p = 0.069). CONCLUSIONS: In Korean women, the observed prevalence of CAD was lower than the PTP, and PTP showed only marginal CAD predictability. Although a positive ETT independently predicted CAD, the ETT showed lower sensitivity and PPVs than previously reported. Despite the limited value of PTP and ETT, the high NPVs of ETT appear useful for saving patients from unnecessary further examinations.
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Kim et al. (2015) conducted a cross-sectional in Suspected coronary artery disease (n=335). Positive exercise treadmill test (ETT) vs. Negative ETT was evaluated on Presence of CAD (OR 3.276, 95% CI 1.643-6.532, p=0.001). A positive exercise treadmill test independently predicted the presence of CAD in Korean women (OR 3.276; 95% CI 1.643-6.532; p=0.001), whereas pretest probability showed marginal predictability.
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