IV Regional Anesthesia

Abstract

Background: There is a wide variation in reported accuracy of noninvasive stress myocardial imaging as a screening tool for coronary artery disease (CAD). This study was undertaken to determine its current accuracy in a wide spectrum of patients with chest pain syndromes using invasive coronary angiography as the gold standard. Methods: The patient population consisted of consecutive patients undergoing coronary angiography in whom noninvasive stress imaging, either nuclear or echocardiographic, was performed within 6 months prior to the angiogram. The specificity, sensitivity, positive and negative predictive values, and diagnostic accuracy for detecting ≥ 1 lesions with ≥ 50% diameter coronary stenosis were determined for each modality. Results: Of the 227 eligible patients, 141 were men and 86 were women; 70% had significant CAD. The diagnostic accuracy overall was 71% and was no different for nuclear or echocardiographic testing. The positive predictive value (86% vs 52%; P = 0.002) and diagnostic accuracy (83% vs 51%; P = 0.002) were better in men than in women. Interpretation: In this study, noninvasive stress imaging lacked the accuracy of a good screening test for significant CAD. This finding was particularly true for women, for whom it was not much better than a coin toss.