A MULTIVARIATE-ANALYSIS OF THE DIAGNOSTIC VALUES OF CLINICAL EXAMINATION, EXERCISE TESTING AND EXERCISE RADIONUCLIDE ANGIOGRAPHY CORONARY-ARTERY DISEASE

Data of clinical examination, exercise testing and exercise radionucli de angiography in 102 patients referred for assessment of chest pain w as included in a logistic regression to optimize the diagnosis of coro nary artery disease with coronary arteriography as the reference inves tigation. None of the patients had other cardiac problems or previous myocardial infarction. In the absence of symptoms, exercise testing wa s continued until at least 80% of the theoretical maximal heart rate w as attained. Each patient was characterized by the value of the logist ic function or probability of coronary artery disease. A threshold val ue corresponding to 80% sensitivity of ROC graphs was determined. The significant variables were: a clinical variable - the type of chest pa in as assessed by the clinical history; two radionuclide angiographic variables - the ejection fraction at peak effort and the corrected var iation of ejection fraction between rest and stress, that is not takin g into account possible decreases at the last increment of exercise. C oronary patients can be identified with an 80% sensitivity and 77% spe cificity on these criteria. This specificity is greater than that obta ined by clinical examination and exercise testing alone (65%). Exercis e radionuclide angiography may therefore reduce the number of unnecess ary coronary arteriographies.