DEVELOPMENT AND VALIDATION OF A CLINICAL SCORE TO ESTIMATE THE PROBABILITY OF CORONARY-ARTERY DISEASE IN MEN AND WOMEN PRESENTING WITH SUSPECTED CORONARY-DISEASE

PURPOSE: Guidelines for the management of patients with suspected coro nary disease have emphasized stratification into groups with low, inte rmediate, and high probability of significant coronary disease. Previo usly derived clinical prediction rules have been difficult to apply in clinical settings. The purpose of this study was to develop and valid ate a clinical score that facilitates this stratification process. PAT IENTS AND METHODS: We performed a retrospective analysis of prospectiv ely acquired data from 915 patients with suspected coronary disease an d normal resting electrocardiograms who presented for exercise testing at a university hospital. All patients subsequently underwent coronar y angiography. Analysis included logistic regression with significant coronary disease (greater than or equal to 1 vessel with a greater tha n or equal to 50% lesion) presence as the dependent variable and clini cal variables as independent variables. From this analysis, a coronary disease score was developed to estimate prevalence of coronary diseas e from clinical variables. Validation of this score was performed in a separate prospectively acquired cohort of 348 patients. RESULTS: For the entire validation group, the prevalence of significant coronary di sease was 16% (10/63) in the low probability group, 44% (86/195) in th e intermediate probability group, and 69% (62/90) in the high probabil ity group. Both men and women were stratified equally well into the 3 probability groups.CONCLUSION: The clinical score is an easily memoriz ed and accurate method for categorizing patients with suspected but no t proven coronary disease and normal resting electrocardiograms into c linically meaningful probability groups upon which decisions concernin g appropriate diagnostic test selection could potentially be based. (C ) by Excerpta Medica, Inc.