INCREMENTAL VALUE OF EXERCISE ELECTROCARDIOGRAPHY AND TL-201 TESTING IN MEN AND WOMEN FOR THE PRESENCE AND EXTENT OF CORONARY-ARTERY DISEASE

Our goal was to assess the incremental value of exercise testing in me n and women for the diagnosis and extent of coronary artery disease. W ith data from one center, incremental logistic algorithms were develop ed and evaluated in a separate set of 865 patients from four centers. Variables included were pretest (age, sex, symptoms, diabetes, smoking , and cholesterol concentration); exercise electrocardiogram (EGG) (ST -segment depression [millimeters], ST-segment slope, peak heart rate, and change in systolic blood pressure); and thallium-201 scintigram (d efect presence, reversibility, and intensity of hypoperfusion). End po ints were coronary disease presence (50% diameter stenosis) and extent (multivessel disease). Accuracy and incremental value were assessed b y receiver operating characteristic (ROC) curve analysis. Incremental ROC curve areas for disease presence were pretest 0.75 +/- 0.02, post- exercise ECG 0.82 +/- 0.01, and post-thallium scintigram 0.85 +/- 0.01 and for disease extent were pretest 0.71 +/- 0.02, post-exercise ECG 0.76 +/- 0.02, and post-thallium scintigram 0.78 +/- 0.02 (p < 0.005 f or all increments). Incremental increases in accuracy were similar for men and women. We conclude that when multivariable algorithms derived from one center were applied to a separate group, there was a signifi cant incremental increase in accuracy associated with exercise testing for the presence and extent of coronary disease. This increase in acc uracy was similar for men and women.