Improving the positive predictive value of exercise testing in women. Issue 12 (14th November 2003)

• Record Type: Journal Article
• Authors: Wong, Y K; Dawkins, S; Grimes, R; Smith, F; Dawkins, K D; Simpson, I A
• Is Part Of: Heart. Volume 89:Issue 12(2003)
• Page Start: 1416
• Page End: 1421
• Publication Date: 2003-11-14
• Subjects: women -- exercise testing -- coronary heart disease -- atherosclerosis -- ST recovery time; CHD, coronary heart disease -- MPI, myocardial perfusion imaging -- ROC, receiver operating characteristic; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heart.89.12.1416
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To identify exercise test variables that can improve the positive predictive value of exercise testing in women. Design: Cohort study. Setting: Regional cardiothoracic centre. Subjects: 1286 women and 1801 men referred by primary care physicians to a rapid access chest pain clinic, of whom 160 women and 406 men had ST depression of at least 1 mm during exercise testing. The results for 136 women and 124 men with positive exercise tests were analysed. Main outcome measures: The proportion of women with a positive exercise test who could be identified as being at low risk for prognostic coronary heart disease and the resulting improvement in the positive predictive value. Results: Independently of age, an exercise time of more than six minutes, a maximum heart rate of more than 150 beats/min, and an ST recovery time of less than one minute were the variables that best identified women at low risk. One to three of these variables identified between 11.8% and 41.2% of women as being at low risk, with a risk for prognostic disease of between 0−11.5%. The positive predictive value for the remaining women was improved from 47.8% up to 61.5%, and the number of normal angiograms was potentially reducible by between 21.1−54.9%. By the same criteria, men had higher risks for prognostic disease. Conclusions: A strategy of discriminating true from false positive exercise tests is worthwhile in women but less successful in men.