Diagnostic Value Of Pre-test Probability Combined With Electrocardiogram Treadmill Test In Patients Suspected For Stable Coronary Artery Disease

Objective: to study the diagnostic value of pre-test probability(PTP)inferred by simplified Updated Diamond-Forrester method(UDFM),electrocardiogram treadmill test(ETT)and their combination in patients suspected for stable coronary artery disease(SCAD).Methods: retrospective analysis was used.The patients who were admitted to the department of cardiovascular medicine,the First Affiliated Hospital of Fujian Medical University for "chest pain" from January 2016 to December 2018,and underwent electrocardiogram treadmill test and coronary angiography(CAG)within 2 weeks were taken as the subjects of the study.The pre-test probability model adopts the simplified UDFM model,from which the pre-test probability(PTP)of the subject is inferred and PTP is used as the grouping basis.The results of coronary angiography were used as the gold standard to analyze the diagnostic value of PTP,ETT and their combination in patients suspected for stable coronary artery disease.Results: 340 eligible subjects were included in this study.(1)Using CAG as the gold standard,the area under the curve(AUC)of receiver operating characteristic curve(ROC)of SCAD predicted by PTP was 0.668(P < 0.05),suggests that the simplified UDFM model has certain diagnostic value for SCAD.(2)Using CAG as the gold standard,the sensitivity,specificity and positive predictive value of ETT in females were lower than those in males,while the negative predictive value was higher than that in males.there was significant difference in positive predictive value between the two groups(P < 0.05).(3)Taking CAG as the gold standard,the sensitivity,specificity,positive predictive value and negative predictive value of ETT in each PTP group were different.CochranArmitage trend test analysis showed that there was a linear trend of positive predictive value and negative predictive value among the three groups.In this study,Females were distributed in low PTP group and low-middle PTP group.the sensitivity,specificity and positive predictive value of low-middle PTP group were higher than those of low PTP group,while the negative predictive value was lower than that of low PTP group.There was significant difference in positive predictive value between the two groups(P < 0.05).Males were distributed in the low-middle PTP group and the high-middle PTP group.The specificity and negative predictive value of low-middle PTP group were higher than those of high-middle PTP group,while the sensitivity and positive predictive value were lower than those of high-middle PTP group.There was significant difference in negative predictive value between the two groups(P < 0.05).In the low-middle PTP group,there was no significant difference in sensitivity,specificity,positive predictive value and negative predictive value between male and female.Conclusion: the simplified UDFM model has certain diagnostic value in Chinese population.There were gender differences in the diagnostic accuracy of ETT in patients suspected for SCAD.The combined use of simplified UDFM model can improve the diagnostic value of ETT in patients suspected for SCAD.