OPTIMAL PHARMACOLOGICAL STRESS-TESTING FOR THE DIAGNOSIS OF CORONARY-ARTERY DISEASE - A PROBABILISTIC APPROACH

Previous reports have suggested that dobutamine stress echocardiograph y compares favourably with other stress agent-imaging modality combina tions for the detection of coronary artery disease. However, in daily clinical practice the value of a test is defined on a probability basi s. To study the relative diagnostic contribution of clinical and dobut amine stress test variables, Bayesian analysis was performed in 223 pa tients with suspected coronary artery disease, who underwent coronary angiography and a high-dose dobutamine stress test in conjunction with electrocardiography, echocardiography and Technetium-99m sestamibi SP ECT myocardial perfusion scintigraphy. According to the pre-test (clin ical) probabilities, patients were divided into low-, intermediate- an d high-risk groups; 155 patients were in the intermediate-visit group. After dobutamine stress echocardiography the number of patients in th is intermediate-risk group was reduced to 102 (P<0.0001). This reducti on of patients in the intermediate-risk group by echocardiography was better than perfusion scintigraphy (102 vs 126 patients, P<0.05) or cl assic markers of ischaemia such as angina and/or ST-segment changes (1 02 vs 150, P<0.0001). Moreover, there was a good correlation between t he echocardiographic post-test probabilities and the true distribution of coronary artery disease.