Exercise electrocardiography for pre-test assessment of the likelihood of coronary artery disease
Authors' conclusion
ExECG incorporated into a clinical likelihood model improves reclassification of patients to a very low clinical likelihood group with very low prevalence of obstructive CAD and favourable prognosis.
Study context
- Population
- Patients with suspected obstructive coronary artery disease (CAD) undergoing exercise ECGtraining cohort 1214
- Comparison
- Exercise electrocardiography (ExECG)-weighted clinical likelihood (ExECG-CL) model vs risk factor-weighted clinical likelihood (RF-CL) model
- Outcome
- Discrimination of obstructive CAD (>50% diameter stenosis on invasive coronary angiography)
Methodological detailsmodel development and validation
- Model development and validation
Performance
As reported in the abstract
Discrimination of obstructive CAD (CAD validation cohort, N=408)
| Test or model | AUC |
|---|---|
| ExECG-CL | 83.1% (95% CI 77.5% to 88.7%) |
| RF-CL | 80.7% (95% CI 74.6% to 86.8%) |
AUC
ExECG-CL83.1% (95% CI 77.5% to 88.7%)
RF-CL80.7% (95% CI 74.6% to 86.8%)
- ExECG-CL vs RF-CL: P = 0.14 — similar discrimination
Further findings
Very low (≤5%) clinical likelihood of obstructive CAD
P < 0.01
Very low (≤5%) clinical likelihood of obstructive CAD
- Obstructive CAD prevalence and event risk remained low in very low likelihood group
Non-fatal MI and death (prognosis validation cohort, N=3283)
- Met the endpoint
- 4.4%
Original publication
Exercise electrocardiography for pre-test assessment of the likelihood of coronary artery disease. Heart. Published 22 August 2023. doi:10.
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