- 作者：Mitalee P. Christman&lowast ; ; Marcio Sommer Bittencourt ; MD ; MPH&dagger ; ; Edward Hulten ; MD ; MPH&dagger ; ; Ekta Saksena ; BA&Dagger ; ; Jon Hainer ; BSc&dagger ; ; Hicham Skali ; MD&dagger ; ; Raymond Y. Kwong ; MD§ ; ; Daniel E. Forman ; MD§ ; ; Sharmila Dorbala ; MD&dagger ; ; Patrick T. O'Gara ; MD§ ; ; Marcelo F. Di Carli ; MD&dagger ; ; Ron Blankstein ; MD&dagger ; ; rblankstein@partners.org" class="auth_mail
- 关键词：downstream testing ; exercise testing ; imaging
- 刊名：Journal of the American College of Cardiology
- 出版年：8 April, 2014
- 年：2014
- 卷：63
- 期：13
- 页码：1264-1274
- 全文大小：1314 K
Objectives
The purpose of this study was to estimate the frequency and results of downstream testing after exercise treadmill tests (ETTs).Background
The utility of additional diagnostic testing after ETT is not well characterized.
Methods
We followed consecutive individuals without known coronary artery disease referred for clinical ETT at a large medical center. We measured the frequency and results of downstream imaging tests and invasive angiography within 6 months of ETT and the combined endpoint of survival free from cardiovascular death, myocardial infarction, and coronary revascularization.
Results
Among 3,656 consecutive subjects who were followed for a mean of 2.5 卤 1.1 years, 332 (9.0%) underwent noninvasive imaging and 84 (2.3%) were referred directly to invasive angiography after ETT. The combined endpoint occurred in 76 (2.2%) patients. The annual incidence of the combined endpoint after negative, inconclusive, and positive ETT was 0.2%, 1.3%, and 12.4%, respectively (p聽< 0.001). Rapid recovery of electrocardiography (ECG) changes during ETT was associated with negative downstream test results and excellent prognosis, whereas typical angina despite negative ECG was associated with positive downstream tests and adverse prognosis (p聽< 0.001). Younger age, female sex, higher metabolic equivalents of task achieved, and rapid recovery of ECG changes were predictors of negative downstream tests.
Conclusions
Among patients referred for additional testing after ETT, the lowest yield was observed among individuals with rapid recovery of ECG changes or negative ETT, whereas the highest yield was observed among those with typical angina despite negative ECG or a positive ETT. These findings may be used to identify patients who are most and least likely to benefit from additional testing.