Accuracy of heart rate–adjusted ST segments in populations with and without posttest referral bias☆,☆☆
Section snippets
Patients
The population was composed of all patients referred by either their primary care physician or cardiologist to the exercise laboratory with suspected coronary artery disease between January 1993 and July 1995. Patients with a history of prior myocardial infarction or coronary angiography, patients receiving digitalis, and those with uninterpretable exercise electrocardiograms, including those with left bundle branch block, left ventricular hypertrophy, Wolff-Parkinson-White syndrome, and other
Population
Table I lists the clinical and exercise characteristics of the 1358 patients included in this study and the subgroups that did and did not undergo coronary angiography. The angiographic subgroup (n = 152) affected by posttest referral bias was very different from the subgroup of 1206 patients who did not undergo angiography. The angiographic group was older and had a greater frequency of angina, hypercholesterolemia, and diabetes. These differences are summarized by considering the significant
Discussion
The topic of heart rate adjustment of ST segments has generated considerable controversy.17, 18, 19, 20, 21, 22 The points of contention have focused on methodologic details and patient population selection. Okin and Kligfield,12 the principal proponents of the method, have published explicit guidelines concerning what they feel are the methodologic factors that affect the performance of heart rate adjustment. This study precisely followed those methodologic recommendations to perform a fair
Acknowledgements
I thank Christine Morise for entering data into a computer spreadsheet.
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Reprint requests: Anthony Morise, MD, Section of Cardiology, HSC-South, Morgantown, WV 26506-9157.
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