ABSTRACT
BACKGROUND: The appropriate management of patients with an intermediate Duke treadmill score (DTS) is not well established.The aim of this study is to compare several treadmill indexes (American College of Cardiology/American Heart Association (ACC/AHA) High-Risk Criteria for exercise testing,Veterans Affairs and West Virginia Prognostic Score, ST/Heart Rate Index, Failure to attain 85% of age-predicted maximum Heart Rate) with ST-segment depression in detecting significant or severe coronary artery disease as determined by coronary angiography in patients with an intermediate DTS. METHODS: 144 consecutive patients admitted to the hospital for unstable angina were studied. RESULTS: The sensitivities of the ACC/AHA High-Risk Criteria and West Virginia Prognostic Score were greater than 95% for the detection of significant coronary artery disease and 96.67% for the detection of severe coronary artery disease. The sensitivity of I mm ST depression for the detection of significant and severe coronary disease was 74.74% and 86.67%, respectively. The combined evaluation of ST-segment depression > or =1 mm and exercise-induced angina could efficiently identify a population with a high prevalence of significant coronary artery disease (specificity of 95.92%, positive predictive value of 94.29%). CONCLUSIONS: The ACC/AHA High-Risk Criteria was West Virginia Prognostic Score provided relevant diagnostic information in patients with an intermediate DTS. A coronary angiography is to be recommended in patients with an intermediate DTS who also present ST-segment depression > or =1 mm and exercise-induced angina.
