Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients

Leslee J. Shaw, Rory Hachamovitch, Gary V. Heller, Thomas H. Marwick, Mark I. Travin, Ami E. Iskandrian, Karen Kesler, Michael S. Lauer, Robert Hendel, Salvador Borges-Neto, Howard C. Lewin, Daniel S. Berman, Donald D Miller

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Effective allocation of medical resources in stable chest pain patients requires the accurate diagnosis of coronary artery disease and the stratification of future cardiac risk. We studied the relative predictive value for cardiac death of 3 commonly applied noninvasive strategies, clinical assessment, stress electrocardiography, and myocardial perfusion tomography, in a large, multicenter population of stable angina patients. The multicenter observational series comprised 7 community and academic medical centers and 8,411 stable chest pain patients. All patients underwent pretest clinical screening followed by stress (exercise 84% or pharmacologic 16%) electrocardiography and myocardial perfusion tomography. Risk-adjusted multivariable Cox proportional hazards models were developed to predict cardiac death. Kaplan-Meier rates of time to cardiac catheterization were also computed. Cardiac mortality was 3% during the 2.5 ± 1.5 years of follow-up. The number of infarcted vascular territories and pretest clinical risk factors were strong predictors of cardiac mortality, whereas the number of ischemic vascular territories gained increasing importance when determining post-test resource use requirements (i.e., the decision to perform cardiac catheterization). Exertional ST-segment depression in a population with a high frequency of electrocardiographic abnormalities at rest was not a significant differentiator of cardiac death risk. Stable chest pain patients are accurately identified as being at high risk for near-term cardiac events by both physicians' screening clinical evaluation and by the results of stress myocardial perfusion imaging. Disease management strategies for stable chest pain patients aimed at risk reduction should incorporate knowledge of relevant end points in treatment and guideline development. Copyright (C) 2000 Excerpta Medica Inc.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalAmerican Journal of Cardiology
Volume86
Issue number1
DOIs
StatePublished - Jul 1 2000

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Chest Pain
Cardiac Catheterization
Blood Vessels
Electrocardiography
Perfusion
Tomography
Myocardial Perfusion Imaging
Stable Angina
Resource Allocation
Mortality
Risk Reduction Behavior
Disease Management
Proportional Hazards Models
Population
Coronary Artery Disease
Guidelines
Exercise
Physicians

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients. / Shaw, Leslee J.; Hachamovitch, Rory; Heller, Gary V.; Marwick, Thomas H.; Travin, Mark I.; Iskandrian, Ami E.; Kesler, Karen; Lauer, Michael S.; Hendel, Robert; Borges-Neto, Salvador; Lewin, Howard C.; Berman, Daniel S.; Miller, Donald D.

In: American Journal of Cardiology, Vol. 86, No. 1, 01.07.2000, p. 1-7.

Research output: Contribution to journalArticle

Shaw, LJ, Hachamovitch, R, Heller, GV, Marwick, TH, Travin, MI, Iskandrian, AE, Kesler, K, Lauer, MS, Hendel, R, Borges-Neto, S, Lewin, HC, Berman, DS & Miller, DD 2000, 'Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients', American Journal of Cardiology, vol. 86, no. 1, pp. 1-7. https://doi.org/10.1016/S0002-9149(00)00819-5
Shaw, Leslee J. ; Hachamovitch, Rory ; Heller, Gary V. ; Marwick, Thomas H. ; Travin, Mark I. ; Iskandrian, Ami E. ; Kesler, Karen ; Lauer, Michael S. ; Hendel, Robert ; Borges-Neto, Salvador ; Lewin, Howard C. ; Berman, Daniel S. ; Miller, Donald D. / Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients. In: American Journal of Cardiology. 2000 ; Vol. 86, No. 1. pp. 1-7.
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