Circulation, Vol 71, 535-542, Copyright © 1985 by American Heart Association
JA Melin, W Wijns, RJ Vanbutsele, A Robert, P De Coster, LA Brasseur, C Beckers and JM Detry
Alternative strategies using conditional probability analysis for the
diagnosis of coronary artery disease (CAD) were examined in 93 infarct-
free women presenting with chest pain. Another group of 42 consecutive
female patients was prospectively analyzed. For this latter group, the
physician had access to the pretest and posttest probability of CAD before
coronary angiography. These 135 women all underwent stress
electrocardiographic, thallium scintigraphic, and coronary angiographic
examination. The pretest and posttest probabilities of coronary disease
were derived from a computerized Bayesian algorithm. Probability estimates
were calculated by the four following hypothetical strategies: SO, in which
history, including risk factors, was considered; S1, in which history and
stress electrocardiographic results were considered; S2, in which history
and stress electrocardiographic and stress thallium scintigraphic results
were considered; and S3, in which history and stress electrocardiographic
results were used, but in which stress scintigraphic results were
considered only if the poststress probability of CAD was between 10% and
90%, i.e., if a sufficient level of diagnostic certainty could not be
obtained with the electrocardiographic results alone. The strategies were
compared with respect to accuracy with the coronary angiogram as the
standard. For both groups of women, S2 and S3 were found to be the most
accurate in predicting the presence or absence of coronary disease (p less
than .05). However, it was found with use of S3 that more than one-third of
the thallium scintigrams could have been avoided without loss of accuracy.
It was also found that diagnostic catheterization performed to exclude CAD
as a diagnosis could have been avoided in half of the patients without loss
of accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Alternative diagnostic strategies for coronary artery disease in women: demonstration of the usefulness and efficiency of probability analysis
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