Author + information
- Received January 11, 1995
- Revision received April 21, 1995
- Accepted May 30, 1995
- Published online November 1, 1995.
- Charles A. Dennis, MD, FACCa,*,1,
- Peter E. Pool, MD, FACCa,*,1,
- Edward J. Perrins, MB, ChB, FACCa,†,
- Syed M. Mohiuddin, MD, FACCa,‡,
- Joel Sklar, MD, FACCa,§,
- William J. Kostuk, MD, FACCa,f,
- David W.M. Muller, MBBS, FACC, FRACPa,¶,
- Mark R. Starling, MD, FACCa,¶,
- for the International Arbutamine Study Groupa
- ↵*Address for correspondence:Dr. Charles A. Dennis, Deborah Heart and Lung Center, 200 Trenton Road. Browns Mills, New Jersey 08015-1705.
Objectives. This study compared exercise and pharmacologic stress testing using arbutamine delivered by a closed-loop device for the detection of coronary artery disease.
Background. Arbutamine, an agent designed to simulate exercise, has been developed in conjunction with a closed-loop delivery device that modulates the rate of administration on the basis of physiologic feedback.
Methods. Two hundred ten patients (180 men, 30 women) with symptoms and angiographic evidence of coronary artery disease were studied. Ischemia was categorized in three ways: 1) the presence of angina; 2) the occurrence of ≥0.1-mV horizontal or downsloping ST segment depression or elevation at 60 ms after the J point; or 3) the presence of either condition 1 or 2.
Results. In the 210 patients, the mean increase in heart rate and systolic blood pressure evoked by arbutamine and exercise was 51 and 53 beats/min (p = NS) and 36 and 44 mm Hg (p < 0.0001), respectively. Arbutamine detected ischemia more often than exercise with each of the three ischemic end points. Sensitivity for detecting ischemia by either angina or ST segment change was 84% (95% confidence interval [CI] 79% to 89%) for arbutamine and 75% (95% CI 69% to 81%) for exercise testing (p = 0.014). For angina alone, sensitivity was 73% (95% CI 67% to 79%) for arbutamine and 64% (95% CI 57% to 71%) for exercise (p = 0.026). For ST segment change alone, sensitivity was 47% (95% CI 40% to 54%) for arbutamine and 44% (95% CI 37% to 51%) for exercise (p = 0.426). Cardiac events occurred in five patients (1.8%) within 24 h of the arbutamine test.
Conclusions. In detecting documented coronary artery disease, the sensitivity of arbutamine testing was equal to that of exercise for the electrocardiographic end point of ST segment change alone. Arbutamine testing was significantly superior to exercise testing for either ST change or angina or for angina alone.
↵1 Drs. Dennis and Pool have a financial interest in Gensia, Inc., and both have been consultants to and hold stock in the company. A list of participating investigators and clinical sites for the International Arbutamine Study Group appears in Appendix 2.
This study was supported in part by Gensia, Inc., San Diego, California.
- Received January 11, 1995.
- Revision received April 21, 1995.
- Accepted May 30, 1995.
- American College of Cardiology