Key result
For the diagnosis of 3-vessel disease, the dipyridamole ECG test demonstrated higher specificity (68% vs 38%, p<0.01) and predictive accuracy (75% vs 54%, p<0.01) than the treadmill test.
Why the study?
Does the dipyridamole electrocardiography test improve the assessment of coronary artery disease severity compared to the treadmill exercise test in patients without myocardial infarction?
Cross-Sectional (n=100)
Does the dipyridamole electrocardiography test improve the assessment of coronary artery disease severity compared to the treadmill exercise test in patients without myocardial infarction?
Absolute Event Rate: 68% vs 38%
p-value: p=<0.01
The dipyridamole ECG test demonstrates higher specificity and predictive accuracy than the treadmill test for identifying severe (3-vessel) coronary artery disease.
May aid severe CAD detection in non-MI patients; hypothesis-generating and requires prospective validation before practice change.
The purpose of this study was to investigate the relationship of dipyridamole-induced ST changes to the severity of coronary artery disease. The subjects were 100 patients without myocardial infarction who underwent coronary arteriography for the diagnosis of coronary artery disease. The dipyridamole injection test (D) (0.568 mg/kg/4 min), and symptom-limited treadmill exercise test (T) were performed separately. Body surface electrocardiographic mapping of 87 leads was performed in both tests. The incidences of significant ST depression greater than or equal to 0.10 mV, number of leads showing significant ST depression (nST) and the maximal voltage of ST depression (maxST) in D and T were compared to the number of diseased coronary arteries. In patients without significant coronary stenosis (0VD group), the incidence of ST depression in the dipyridamole test was significantly lower than that in the treadmill test (D 9% vs T 47%, p less than 0.01). While, in one vessel disease (1VD), two vessel disease (2VD), and three vessel disease (3VD) groups, there was no significant difference in the incidence of ST depression between the dipyridamole test and the treadmill test (in 1VD, D 44% vs. T 65%; in 2VD, D 67% vs. T 93%; and in 3VD, D 93% vs. T 96%). In the dipyridamole test, nST was 0.6 +/- 2.4 in 0VD, 4.5 +/- 6.9 in 1VD, 4.1 +/- 4.5 in 2VD, and 10.6 +/- 8.1 in 3VD. Significant differences were found between 0VD and 1VD (P less than 0.05), 0VD and 3VD (P less than 0.01), 1VD and 3VD (P less than 0.01), and 2VD and 3VD (p less than 0.01). The maxST in the dipyridamole test was 0.02 +/- 0.04 mV in 0VD, 0.10 +/- 0.12 mV in 1VD, 0.13 +/- 0.11 mV in 2VD, and 0.22 +/- 0.11 mV in 3VD. Significant differences were found between 0VD and 1VD (p less than 0.01), 0VD and 2VD (p less than 0.01), 0VD and 3VD (p less than 0.01), 1VD and 3VD (p less than 0.01), and 2VD and 3VD (P less than 0.01). For the diagnosis of 3VD, the dipyridamole ECG test had as high a sensitivity (93% vs 96%), higher specificity (68% vs 38%, p less than 0.01), and higher predictive accuracy (75% vs 54%, p less than 0.01) than the treadmill test.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ikeda et al. (1992) conducted a cross-sectional in Coronary artery disease (n=100). Dipyridamole electrocardiography test vs. Symptom-limited treadmill exercise test was evaluated on Specificity for the diagnosis of 3-vessel disease (p=<0.01). For the diagnosis of 3-vessel disease, the dipyridamole ECG test demonstrated higher specificity (68% vs 38%, p<0.01) and predictive accuracy (75% vs 54%, p<0.01) than the treadmill test.
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