Clinical variables showed only modest accuracy in predicting inducible sustained ventricular tachycardia in patients with coronary artery disease (receiver operator characteristic area <0.70).
Cohort (n=1,721)
Yes
Can clinical variables predict inducible sustained monomorphic ventricular tachycardia in patients with coronary artery disease, left ventricular dysfunction, and nonsustained ventricular tachycardia?
Clinical variables have limited utility in predicting inducible sustained ventricular tachycardia and cannot replace electrophysiological testing for risk stratification in patients with CAD, LV dysfunction, and NSVT.
Effect estimate: ROC area <0.70
BACKGROUND: Cardiologists often use clinical variables to determine the need for electrophysiological studies to stratify patients for risk of sudden death. It is not clear whether this is rational in patients with coronary artery disease, left ventricular dysfunction, and nonsustained ventricular tachycardia. METHODS AND RESULTS: We analyzed the first 1721 patients enrolled in the Multicenter UnSustained Tachycardia Trial to determine whether clinical variables could predict which patients would have inducible sustained monomorphic ventricular tachycardia. The rate of inducibility of sustained ventricular tachycardia was significantly higher in patients with a history of myocardial infarction and in men compared with women. There was a progressively increased rate of inducibility with increasing numbers of diseased coronary arteries. There was a significantly lower rate of inducibility in patients with prior coronary artery bypass surgery and in patients who also had noncoronary cardiac disease. The rate of inducibility was higher in patients of white race, patients with recent (</=6 weeks) angina, left ventricular dyskinesis, and in patients with greater numbers of fixed thallium defects. Inducibility was more likely in patients who had a prior myocardial infarction complicated by congestive heart failure, ventricular tachycardia, or fibrillation </=48 hours after the onset of infarction. Although these associations are statistically significant, the accuracy of the clinical variables in discriminating between patients with and those without inducible ventricular tachycardia is only modest (receiver operator characteristic area <0.70). CONCLUSIONS: Multiple clinical variables are independently associated with inducible sustained ventricular tachycardia. However, they have limited utility to guide clinical decisions regarding the use of electrophysiological testing for risk stratification in this patient population.
Buxton et al. (Tue,) conducted a cohort in Coronary artery disease, left ventricular dysfunction, and nonsustained ventricular tachycardia (n=1,721). Clinical variables was evaluated on Inducible sustained monomorphic ventricular tachycardia (ROC area <0.70). Clinical variables showed only modest accuracy in predicting inducible sustained ventricular tachycardia in patients with coronary artery disease (receiver operator characteristic area <0.70).