PROGNOSTIC VALUE OF A TREADMILL EXERCISE SCORE IN OUTPATIENTS WITH SUSPECTED CORONARY-ARTERY DISEASE
PROGNOSTIC VALUE OF A TREADMILL EXERCISE SCORE IN OUTPATIENTS WITH SUSPECTED CORONARY-ARTERY DISEASE
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DOI：
10.1056/nejm199109193251204
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发表时间：
1991-09-19
影响因子：
158.5
通讯作者：
PRYOR, DB
中科院分区：
文献类型：
--
作者：
MARK, DB;SHAW, L;PRYOR, DB
背景踏车运动试验可以识别出不同程度的心血管事件死亡风险的患者。我们根据平板运动试验的结果设计了一个预后评分，它能准确地预测接受心导管检查的住院患者的预后。本研究旨在确定该评分是否也能准确预测门诊患者的预后。我们前瞻性地研究了613例在1983年至1985年间被转诊进行运动试验的疑似冠心病的连续门诊患者。四年随访完成率为98%。运动评分计算如下：运动持续时间（分钟）-（5 ×运动期间或运动后最大ST段偏移（毫米））-（4 ×运动心绞痛指数）。运动平板心绞痛指数为0表示无心绞痛，1表示非限制性心绞痛，2表示运动限制性心绞痛。跑步机评分范围从-25（表示最高风险）到+15（表示最低风险）。根据门诊患者的跑步机评分预测的结果与观察到的结果密切一致。该评分准确区分了随后死亡的患者和存活4年的患者（受试者工作特征曲线下面积= 0.849）。跑步机评分是一个比临床数据更好的评价，对门诊患者比住院患者更有用。大约三分之二的门诊患者的跑步机评分表明风险较低（大于或等于+5），反映了较长的运动时间和很少或没有ST段偏移，他们的四年生存率为99%（平均年死亡率为0.25%）。4%的门诊患者的评分表明高风险（<-10），反映了较短的运动时间和更严重的ST段偏移;他们的4年生存率为79%（平均年死亡率为5%）。活动平板评分是一个有用和有效的工具，可以帮助临床医生确定预后，并决定是否转诊门诊可疑冠心病患者进行心导管插入术。本研究与临床评估相比，它是一个更好的结果预测器。
Background. The treadmill exercise test identifies patients with different degrees of risk of death from cardiovascular events. We devised a prognostic score, based on the results of treadmill exercise testing, that accurately predicts outcome among inpatients referred for cardiac catheterization. This study was designed to determine whether this score could also accurately predict prognosis in unselected outpatients.Methods. We prospectively studied 613 consecutive outpatients with suspected coronary disease who were referred for exercise testing between 1983 and 1985. Follow-up was 98 percent complete at four years. The treadmill score was calculated as follows: duration of exercise in minutes - (5 x the maximal ST-segment deviation during or after exercise, in millimeters) - (4 x the treadmill angina index). The numerical treadmill angina index was 0 for no angina, 1 for nonlimiting angina, and 2 for exercise-limiting angina. Treadmill scores ranged from -25 (indicating the highest risk) to +15 (indicating the lowest risk).Results. Predicted outcomes for the outpatients, based on their treadmill scores, agreed closely with the observed outcomes. The score accurately separated patients who subsequently died from those who lived for four years (area under the receiver-operating-characteristic curve = 0.849). The treadmill score was a better discriminator than the clinical data and was even more useful for outpatients than it had been for inpatients. Approximately two thirds of the outpatients had treadmill scores indicating low risk (greater-than-or-equal-to +5), reflecting longer exercise times and little or no ST-segment deviation, and their four-year survival rate was 99 percent (average annual mortality rate, 0.25 percent). Four percent of the outpatients had scores indicating high risk (< - 10), reflecting shorter exercise times and more severe ST-segment deviation; their four-year survival rate was 79 percent (average annual mortality rate, 5 percent).Conclusions. The treadmill score is a useful and valid tool that can help clinicians determine prognosis and decide whether to refer outpatients with suspected coronary disease for cardiac catheterization. In this study. it was a better predictor of outcome than the clinical assessment.