Comparative accuracy of clinical tests for diagnosis and prognosis of coronary artery disease.
Comparative accuracy of clinical tests for diagnosis and prognosis of coronary artery disease.
复制标题
冠状动脉疾病诊断和预后临床测试的比较准确性。
DOI：
10.1016/0002-9149(88)90889-2
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Diamond,GA
中科院分区：
文献类型：
--
作者：
Bobbio,M;Pollock,BH;Cohen,I;Diamond,GA
对607例冠状动脉造影术患者的临床评价、心脏透视、运动心动图、放射性核素心动图、铊核素心动图等14个变量对冠状动脉造影诊断冠心病的准确性进行了评价，并对4104例患者进行了1年的随访，评价了其对心脏死亡或非致死性心肌梗死预后的判断准确性。判别准确率(以每个变量的受试者-操作特征曲线下的面积量化)在诊断上从50%到73%，在预后上在54%到77%之间。虽然不同的测试有很大的变异性，但代表心肌缺血的直接或间接表现的变量往往与预后更相关。因此，来自放射性核素血管造影术和铊闪烁造影术的变量往往具有比诊断准确率更高的预后准确性，而透视往往具有更多的诊断准确性而不是预后准确性。与临床评估和运动心电图相关的模式较难辨别。因此，非侵入性检查对冠心病诊断和预后的准确性应根据个体经验观察而单独确定。
The discriminant accuracy of 14 variables derived from clinical evaluation, cardiac fluoroscopy, exercise electrocardiography, thallium scintigraphy and radionuclide angiography was assessed with respect to the diagnosis of angiographic coronary artery disease (CAD) among 607 patients undergoing coronary angiography, and with respect to the prognosis of subsequent cardiac death or nonfatal infarction among 4,104 patients followed for 1 year after testing. Discriminant accuracy (quantified in terms of the area under a receiver-operating characteristic curve for each variable) ranged from 50 to 73% for diagnosis, and from 54 to 77% for prognosis. Although there was a great deal of variability from test to test, variables representing direct or indirect manifestations of myocardial ischemia tended to correlate better with prognosis. Thus, variables derived from radionuclide angiography and thallium scintigraphy tended to have more prognostic accuracy than diagnostic accuracy, while fluoroscopy tended to have more diagnostic accuracy than prognostic accuracy. The pattern associated with clinical evaluation and exercise electrocardiography was less discernable. Accordingly, the accuracy of noninvasive tests with respect to diagnosis and prognosis of CAD should be separately determined based on individual empiric observation.