Original ArticleUse of a Simple Clinical Score to Predict Prognosis of Patients With Normal or Mildly Abnormal Resting Electrocardiographic Findings Undergoing Evaluation for Coronary Artery Disease
Section snippets
Initial Development of the Clinical Score
As reported previously,3 the initial (retrospective) study population consisted of 680 consecutive patients with known or suspected CAD who underwent exercise radionuclide angiography between July 10, 1980, and November 25, 1983, and cardiac catheterization within 6 months of the radionuclide angiogram. Patients were excluded from the study if they had previously undergone percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) or had left bundle branch
Study Population Characteristics
The baseline characteristics of the study group (Table 1) reflect the broad selection criteria. Sex was almost equally balanced. The most common symptom was atypical angina. Few patients had noncardiac chest pain or dyspnea. Hypertension, hypercholesterolemia, and smoking were each present in about half of the patients. Diabetes, insulin use, and a history of previous MI each occurred in 10% or less of the patients.
Prognostic Value of Clinical Score
Among the patients with a normal resting ECG result, there were 29 cardiac
DISCUSSION
The clinical score was developed by using a retrospective analysis population of patients referred for exercise radionuclide angiography to predict the presence of angiographic triple-vessel or left main CAD. It is well documented that the presence of anatomically severe CAD is associated with an adverse prognosis compared with less extensive disease.12, 13, 14, 15 Therefore, the results of this prospective application of the score to predict patient outcomes are not surprising. The clinical
Acknowledgments
We thank Rose M. Busta for preparation of the submitted manuscript.
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Cited by (36)
2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/Non-ST-Elevation myocardial infarction: A report of the american college of cardiology Foundation/American Heart Association task force on practice guidelines
2013, Journal of the American College of CardiologyCitation Excerpt :One study found that for males, age younger than 40 years, 40 to 55 years, and older than 55 years and for females, age younger than 50 years, 50 to 65 years, and older than 65 years was correlated with low, intermediate, and high risk for CAD, respectively (145). Another study found that the risk of CAD increased in an incremental fashion for each decade above age 40 years, with male sex being assigned an additional risk point (146,147). In these studies, being a male older than 55 years or a female older than 65 years outweighed the importance of all historical factors, including the nature of the chest pain (145,146).
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease
2012, Journal of the American College of CardiologyCitation Excerpt :One study (249) developed a simple risk score for predicting severe (left main or 3-vessel) CAD that was based on 5 clinical variables: age, sex, history of MI, presence of typical angina, and diabetes mellitus with or without insulin use. This same score was validated subsequently for prognostic purposes (250,251). This score can be easily memorized and calculated (Figure 11) and yields an integer ranging from 0 to 10 (57).
Improving risk stratification in patients with chest pain: The Erlanger HEARTS<inf>3</inf> score
2012, American Journal of Emergency MedicineHighly Sensitive Troponin Immunoassays. Navigating Between the Scylla and Charybdis.
2012, Advances in Clinical Chemistry2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
2011, Journal of the American College of CardiologyCitation Excerpt :Another study found that the risk of CAD increased in an incremental fashion for each decade above age 40 years, with male sex being assigned an additional risk point (139,140). In these studies, being a male older than 55 years or a female older than 65 years outweighed the importance of all historical factors, including the nature of the chest pain (138,139). The characteristics of angina, which are thoroughly described in the ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina (4), include deep, poorly localized chest or arm discomfort that is reproducibly associated with physical exertion or emotional stress and is relieved promptly (i.e., in less than 5 min) with rest and/or the use of sublingual NTG.
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Dr Ho is now with the National University Hospital, Singapore, Republic of Singapore