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• W2324409834 abstract "The study goal was to improve the accuracy of pretest likelihood analysis in determining the need for diagnostic stress testing. We recruited 801 patients with chest pain or dyspnea referred for diagnostic testing. There were 495 females (mean age 60+/− 10) and 301 males (mean age 58+/−11). There were 96 of 340 patients undergoing exercise ECG and SPECT with inducible ischemia, 99/337 having dipyridamole SPECT with ischemia, 8/107 having exercise echocardiography with ischemia and 13/13 undergoing coronary angiography after stress testing having >80% major vessel stenosis. They completed a questionnaire consisting of 10 descriptive chest pain questions, a GERD and 4 psychological inventories and all traditional risk factor questions. They also underwent anthropometric and cardiovascular examination, resting ECG, fasting glucose, haemoglobin A1C, creatinine, triglycerides, HDL and non HDL cholesterol, LDL cholesterol, apoB and homocysteine determinations. Logistic regression models were developed using a randomly selected learning set of 623 patients (80% of total). Their accuracy was tested in a validation set of 173 patients against Morise and CADENZA, two previously validated pretest models for coronary artery disease. In the learning set, a 3- question chest pain score in males and a 5- question chest pain score in females both outperformed the traditional angina score used by Morise and CADENZA in determining angiographic coronary artery disease pretest probablilty. A tabular summary of these scores is given below:Tabled 1 In the validation set, a male model for inducible ischemia with the 3 variables of age, male chest pain score and lipid index gave an AUC of 0.804 on ROC analysis versus 0.780 for CADENZA and 0.736 for Morise. A separate female model for inducible ischemia with the 5 variables of age, female chest pain score, BMI, diabetes and HDL cholesterol gave an AUC of 0.706 versus 0.672 for CADENZA and 0.607 for Morise. Finally, the logistic regression models were converted into simplified gender specific pretest scores with cut points for low, intermediate and high risk for inducible ischemia. The male scoring and performance in the validation set is illustrated below:Tabled 1 The point-of-care application of these new scores should permit the clinician to more confidently exclude men and women with low probability of ischemia from diagnostic stress testing and may lead to a cost savings in the management of chest pain." @default.
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• W2324409834 date "2011-09-01" @default.
• W2324409834 modified "2023-10-01" @default.
• W2324409834 title "573 Gender specific models for predicting inducible myocardial ischemia from chest pain characteristics and biological risk factors" @default.
• W2324409834 doi "https://doi.org/10.1016/j.cjca.2011.07.473" @default.
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