CORONARY SCREENING IN A HIGH RISK SUBSET

我们建议检验这一假设，即冠心病的长期风险 冠状动脉钙化压可准确预测疾病 沉淀物，通过心脏透视筛查发现。我们还将 评估这是否是更敏感的筛查方法(无损失 特异性)，而不是运动试验。选择的两项非侵入性测试 可以很容易地单独或一起应用于大规模筛查 程序并用于测试疾病过程的不同方面 (生理学与解剖学)。运动试验在筛查中的作用 受到其相对较低的灵敏度的限制，因为它只能检测到 动脉粥样硬化斑块大到足以显著阻碍冠状动脉血流。 尖端的透视技术对检测更敏感 动脉粥样硬化斑块，也可能用于预测冠状动脉事件。 一项涉及两种测试的单一筛查前瞻性流行病学研究将 对825名有至少15%弗雷明翰风险的美国退伍军人进行了调查 冠心病的概率将由以下因素定义 病史的流行病学终点将在基线上进行， 并将对受试者进行为期六年的年度访问和接触 与初级内科医生一起确定冠心病的发生 疾病。运动试验的敏感性和特异性 透视检查与冠心病发病率的关系将是 进行了测定和比较。每项测试的预测性效用，与 独立于其他测试的冠状动脉事件的六年发生率 和基线风险因素，将通过Logistic分析进行评估。

We propose to test the hypothesis that the long-term risk of coronary heart disease can be accurately predicted by the pressure of coronary calcific deposits, detected by screening with cardiac fluoroscopy. We will also evaluate whether this is a more sensitive method of screening (without loss of specificity) than is exercise testing. The two noninvasive tests chosen could easily be applied alone or together in a large-scale screening program and be used to test different aspects of the disease process (physiology versus anatomy). The utility of exercise testing for screening has been limited by its relatively low sensitivity since it can only detect atherosclerotic plaque large enough to significantly impede coronary flow. Sophisticated fluoroscopic techniques are more sensitive for detecting atherosclerotic plaque and probably for predicting coronary events as well. A single screen prospective epidemiological study involving both test will be conducted on 825 American veterans with at least a 15% Framingham risk probability of coronary heart disease which will be defined by the epidemiologic endpoints of medical history will be conducted at baseline, and subjects will be followed for six years with annual visits and contacts with the primary physicians to ascertain occurrence of coronary heart disease. The sensitivity and specificity of exercise testing and fluoroscopy in relation to the incidence of coronary heart disease will be determined and compared. The predictive utility of each test, relation to the six-year incidence of coronary events, independent of the other test and baseline risk factors, will be assessed by logistic analysis.