Utility of pretest probability and exercise treadmill test in Korean women with suspected coronary artery disease

Yong Hyun Kim, Wan Joo Shim, Myung A. Kim, Kyung Soon Hong, Mi Seung Shin, Seong-Mi Park, Kyoung Im Cho, Mina Kim, Sihun Kim, Hak Lyoung Kim, Hyun Ju Yoon, Jin Oh Na, Sung Eun Kim

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Abstract

Background: Pretest probability (PTP) and an exercise treadmill test (ETT) are recommended for the initial evaluation of possible coronary artery disease (CAD), but the applicability of these tests in Korean women has not been evaluated. Methods: Korean women with PTP, ETT, and invasive coronary angiography results were enrolled. Across all PTP levels, PTP and ETT statistics were evaluated and independent CAD predictors obtained. Results: Of the 335 patients (mean age 58.0 ± 10.2 years), 99 and 236 were in the low (LPTP) and intermediate PTP (IPTP) groups, respectively. The observed prevalence of CAD was significantly lower than the PTP. (7.1% vs. 9.1 ± 4.9% in LPTP, p < 0.001; 23.3% vs. 33.0 ± 15.1% in IPTP, p < 0.001) The ETT's sensitivity and positive predictive values (PPVs) appeared lower than previously reported (LPTP: 42.9% and 16.7%; IPTP: 61.8% and 37.0%), whereas the negative predictive values (NPVs) were higher (LPTP: 95.1%; IPTP: 85.4%). After multivariate adjustments, positive ETT (odds ratio 3.276, 95% confidence interval 1.643-6.532, p = 0.001) independently predicted the presence of CAD, but the PTP showed only marginal predictability (odds ratio 1.019, 95% confidence interval 0.998-1.041, p = 0.069). Conclusions: In Korean women, the observed prevalence of CAD was lower than the PTP, and PTP showed only marginal CAD predictability. Although a positive ETT independently predicted CAD, the ETT showed lower sensitivity and PPVs than previously reported. Despite the limited value of PTP and ETT, the high NPVs of ETT appear useful for saving patients from unnecessary further examinations.

Original languageEnglish
Pages (from-to)617-622
Number of pages6
JournalJournal of Women's Health
Volume25
Issue number6
DOIs
Publication statusPublished - 2016 Jun 1

ASJC Scopus subject areas

  • Medicine(all)

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    Kim, Y. H., Shim, W. J., Kim, M. A., Hong, K. S., Shin, M. S., Park, S-M., Cho, K. I., Kim, M., Kim, S., Kim, H. L., Yoon, H. J., Na, J. O., & Kim, S. E. (2016). Utility of pretest probability and exercise treadmill test in Korean women with suspected coronary artery disease. Journal of Women's Health, 25(6), 617-622. https://doi.org/10.1089/jwh.2015.5242