Author + information
- Received July 3, 1985
- Revision received March 4, 1986
- Accepted March 11, 1986
- Published online August 1, 1986.
- Olivier Ameisen, MD1,2,
- Paul Kligfield, MD, FACC*,1,
- Peter M. Okin, MD1,
- David H. Miller, MD, FACC1 and
- Jeffrey S. Borer, MD, FACC1,3
- ↵*Address for reprints: Paul Kligfield, MD, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, New York 10021.
The exercise electrocardiographic ST segment/heart rate slope accurately identifies three vessel coronary disease in patients with stable angina, but the method is less accurate in predischarge testing after recent myocardial infarction. To assess the effect of both recent (<3 weeks) infarction and remote (>8 weeks) Q wave infarction on the ST segment/heart rate slope, the predictive value of a slope greater than 6.0 μV/beat per min for the identification of three vessel coronary artery disease was evaluated in 113 patients.
The 58 patients with stable angina, including 17 with remote Q wave myocardial infarction, were similar to the 55 patients with recent myocardial infarction with respect to age and peak exercise heart rate. In patients with stable angina and no prior Q wave myocardial infarction, an ST segment/heart rate slope greater than 6.0 had a sensitivity of 92% (11 of 12), a specificity of 97% (28 of 29) and a positive predictive value of 92% (11 of 12) for three vessel coronary artery disease. In patients with stable angina and remote Q wave infarction, sensitivity was 83% (5 of 6), specificity was 91% (10 of 11) and positive predictive value was 83% (5 of 6).
After recent infarction, test specificity for three vessel disease was preserved at 95% (39 of 41), but test sensitivity was poor (3 of 8). This was confirmed by evaluation of six additional recent patients with infarction and three vessel disease. Among the combined group with recent infarction, test sensitivity for three vessel disease was only 29% (4 of 14), significantly lower than in patients with stable angina (p < 0.005). The markedly reduced sensitivity and positive predictive value after recent myocardial infarction are important limitations of the ST segment/heart rate slope, but the method is highly accurate for the identification of three vessel coronary artery disease in patients with stable angina.
- Received July 3, 1985.
- Revision received March 4, 1986.
- Accepted March 11, 1986.
- American College of Cardiology Foundation