Exercise treadmill testing is frequently performed to screen for coronary artery disease (CAD) in asymptomatic individuals ; however, its clinical value is unclear.
We examined a consecutive cohort of asymptomatic adults undergoing exercise treadmill testing at the Cleveland Clinic Foundation between September 1990 and December 1993.
End points included (1) identification of subjects with severe CAD and (2) performance of any second diagnostic study within 90 days of the index exercise treadmill test.
Screening exercise treadmill testing was performed in 4,334 adults (median age 51,89% men) ; only 34% had =1 cardiac risk factor and 15% exhibited an abnormal response to exercise.
A second test after treadmill testing was performed in 215 patients (in 110, coronary angiography ; in 105, stress thallium scintigraphy, followed by coronary angiography in 16).
The strongest predictor of referra for a second test was an ischemic ST-segment response (adjusted odds ratio [OR] 34,95% confidence intervals [CI] 24 to 47, p<0.0001).
The only clinical variable independently associated with referral for a second test was female gender (adjusted OR 0.35,95% Cl 0.21 to 0.60, p<0.0001).
Of the 126 patients who underwent coronary angiography, severe CAD was identified in only 19 individuals (0.44% of the original cohort, 95% Cl 0.26% to 0.62%) ; coronary artery bypass grafting was performed in 14 of these patients. (...)
Mots-clés Pascal : Cardiopathie coronaire, Asymptomatique, Epreuve tapis roulant, Coût, Economie santé, Dépistage, Homme, Appareil circulatoire pathologie
Mots-clés Pascal anglais : Coronary heart disease, Asymptomatic, Treadmill exercise, Costs, Health economy, Medical screening, Human, Cardiovascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0110666
Code Inist : 002B12A03. Création : 22/06/1998.