Document Detail


Review of studies using multivariable analysis of clinical and exercise test data to predict angiographic coronary artery disease.
MedLine Citation:
PMID:  9122426     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Multivariable analysis of clinical and exercise test variables has the potential to become both a useful tool for assisting in the diagnosis of coronary artery disease and reducing the cost of evaluating patients with suspected coronary disease. Managed care and capitation require that tests such as the exercise test or its replacements, be used only when they can accurately and reliably identify which patients need medications, counseling, or further evaluation or intervention. The replacements for the standard exercise electrocardiogram test require expensive equipment and personnel, and their incremental value is currently being evaluated. Because general practitioners are to function as gatekeepers and decide which patients must be referred to the cardiologist, they will need to use the basic tools they have available (ie, history, physical exam, and the exercise test) in an optimal fashion. However, the discriminating power of the variables from the medical history and exercise test remains unclear because of inadequate study design and differences in study populations. There is a need for further evaluation of these routinely obtained variables to improve the accuracy of prediction algorithms especially in women. Of paramount concern is the need to avoid workup bias by having patients agree to testing before the decision for angiography is made. The portability and reliability of these equations must be shown because access to specialized care must be safeguarded. By reviewing the available studies considering clinical and exercise test variables to predict coronary angiographic findings, we have attempted to provide guidelines and recommendations for a more uniform approach to this endeavor in future investigations. Hopefully, the next generation of multivariable equations will be robust and portable, and empower the clinician to assure the cardiac patient access to appropriate cardiac care.
Authors:
H Yamada; D Do; A Morise; J E Atwood; V Froelicher
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Progress in cardiovascular diseases     Volume:  39     ISSN:  0033-0620     ISO Abbreviation:  Prog Cardiovasc Dis     Publication Date:    1997 Mar-Apr
Date Detail:
Created Date:  1997-04-24     Completed Date:  1997-04-24     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0376442     Medline TA:  Prog Cardiovasc Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  457-81     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, Veterans Affairs Palo Alto Health Care System, Stanford University Palo Alto, CA 94304, USA.
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MeSH Terms
Descriptor/Qualifier:
Coronary Angiography*
Coronary Artery Bypass
Coronary Disease / diagnosis*,  surgery
Exercise Test*
Humans
Multivariate Analysis
Predictive Value of Tests
Research Design

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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