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Previous Volume 301:230-235 August 2, 1979 Number 5 Next

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Abstract

To determine to what extent the diagnostic accuracy of stress testing is influenced by the prevalence of coronary-artery disease, we correlated the description of chest pain, the result of stress testing and the results of coronary arteriography in 1465 men and 580 women from a multicentered clinical trial. The pre-test risk (prevalence of coronary-artery disease) varied from 7 to 87 per cent, depending on sex and classification of chest pain. A positive stress test increased the pre-test risk by only 6 to 20 per cent, whereas a negative test decreased the risk by only 2 to 28 per cent. Aothough the percentage of false-positive results differed between men and women (12 +/- 1 per cent versus 53 +/- 3 per cent P less than 0.001), this difference was not seen in a subgroup matched for prevalence of coronary-artery disease. We conclude that the ability of stress testing to predict coronary-artery disease is limited in a heterogeneous population in which the prevalence of disease can be estimated through classification of chest pain and the sex of the patient.

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• Miller, T. D., Christian, T. F., Allison, T. G., Squires, R. W., Hodge, D. O., Gibbons, R. J. (2000). Is Rest or Exercise Hypertension a Cause of a False-Positive Exercise Test?*. Chest 117: 226-232 [Abstract] [Full Text]  
• Lewis, J. F., Lin, L., McGorray, S., Pepine, C. J., Doyle, M., Edmundowicz, D., Holubkov, R., Pohost, G., Reichek, N., Rogers, W., Sharaf, B. L., Sopko, G., Merz, C. N. B. (1999). Dobutamine stress echocardiography in women with chest pain: Pilot phase data from the National Heart, Lung and Blood Institute Women's Ischemia Syndrome Evaluation (WISE). J Am Coll Cardiol 33: 1462-1468 [Abstract] [Full Text]  
• Cortigiani, L., Dodi, C., Paolini, E. A., Bernardi, D., Bruno, G., Nannini, E. (1998). Prognostic value of pharmacological stress echocardiography in women with chest pain and unknown coronary artery disease. J Am Coll Cardiol 32: 1975-1981 [Abstract] [Full Text]  
• Roger, V. L., Jacobsen, S. J., Pellikka, P. A., Miller, T. D., Bailey, K. R., Gersh, B. J. (1998). Gender differences in use of stress testing and coronary heart disease mortality: a population-based study in Olmsted County, Minnesota. J Am Coll Cardiol 32: 345-352 [Abstract] [Full Text]  
• Roger, V. L., Pellikka, P. A., Bell, M. R., Chow, C. W.H., Bailey, K. R., Seward, J. B (1997). Sex and Test Verification Bias: Impact on the Diagnostic Value of Exercise Echocardiography. Circulation 95: 405-410 [Abstract] [Full Text]  
• Auerbach, I., Chouraqui, P., Motro, M., Douglas, P. S., Ginsburg, G. S. (1996). Chest Pain in Women. NEJM 335: 820-821 [Full Text]  
• Douglas, P. S., Ginsburg, G. S. (1996). The Evaluation of Chest Pain in Women. NEJM 334: 1311-1315 [Full Text]  
• North of England Stable Angina Guideline Developme, (1996). North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of stable angina. BMJ 312: 827-832 [Full Text]  
• Barthelemy, J.-C., Roche, F., Gaspoz, J.-M., Geyssant, A., Minini, P., Antoniadis, A., Page, E., Wolf, J.-E., Wilner, C., Isaaz, K., Cavallaro, C., Lacour, J.-R. (1996). Maximal Blood Lactate Level Acts as a Major Discriminant Variable in Exercise Testing for Coronary Artery Disease Detection in Men. Circulation 93: 246-252 [Abstract] [Full Text]  
• Ginsberg, H. N., Jones, J., Blaner, W. S., Thomas, A., Karmally, W., Fields, L., Blood, D., Begg, M. D. (1995). Association of Postprandial Triglyceride and Retinyl Palmitate Responses With Newly Diagnosed Exercise-Induced Myocardial Ischemia in Middle-Aged Men and Women. Arterioscler. Thromb. Vasc. Bio. 15: 1829-1838 [Abstract] [Full Text]  
• Okin, P. M., Kligfield, P. (1995). Gender-Specific Criteria and Performance of the Exercise Electrocardiogram. Circulation 92: 1209-1216 [Abstract] [Full Text]  
• Jackson, G (1994). Coronary artery disease and women. BMJ 309: 555-557 [Full Text]  
• Grauer, K. (1993). Exercise Tolerance Test: The Decision to Refer. Arch Fam Med 2: 1221-1222 [Abstract]  
• Wenger, N. K., Speroff, L., Packard, B. (1993). Cardiovascular Health and Disease in Women. NEJM 329: 247-256 [Full Text]  
• Sainfort, F. (1991). Eualuation of Medical Technologies: A Generalized ROC Analysis. Med Decis Making 11: 208-220 [Abstract]  
• Dawson, N. V., Cebul, R. D. (1990). Advances in Quantitative Techniques for Making Medical Decisions: The Last Decade. Eval Health Prof 13: 37-62 [Abstract]  
• Hickam, D. H., Sox, H. C. JR, Marton, K. I., Skeff, K. M., Chin, D. (1982). A Study of the Implicit Criteria Used in Diagnosing Chest Pain. Med Decis Making 2: 403-414