Value of Exercise Treadmill Score for Precdicting the Severity of Coronary Artery Disease

Seo, Jeong Pyeong; Cho, In Jong; Rheu, Mun Hee; Park, Jong Soo; Lee, Myung Kon; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

OBJECTIVES
The treadmill exercise eletrocardiography(ECG) is the most commonly used non-invasive method in the evaluation of patients with chest pain. But the accuracy of treadmill exercise ECG in detecting the coronary artery disease(CAD) is still controversial. To improve the accuracy of the treadmill exercise test, exercise treadmill score(ETS) based on exercise duration, degree of ST deviation, and treadmill anginal index during treadmill exercise ECG has been used.
METHODS
The authors calculated ETS by simple equation(total exercise duration-5 X maximal ST-segment deviation during or after exercise-4 X treadmill angina index) and analyzed coronary angiograms of 173 patients(mean age '55.5 +/- 8.7, male: female=2.7: 1) who underwent treadmill exercise ECG and coronary angiography in Chonnam University Hospital from January, 1990 through March, 1993.
RESULTS
1) The studied subjects were subdivided into 3groups according to ETS. Group A(high risk, ETSETS>or=11) 71cases(mean age 60.2 +/- 7.4, male: female=3.3:1), group C(low risk, ETS>5) 87cases(mean age 54.8 +/- 9.2, male-female =2.5:1). Clinical diagnoses of the studiedsubjects were 63stable angina, 61unstable angina, 3acute myocardial infarction, and 46 old myocardial infarction. On coronary angiographic findings, 61patients had single vessel disesase, 23patients had two vessel disease and 13patients had three vessel disease. 2) The sensitivity of the treadmill exercise ECG in diagnosing coronary artery disease was 88% and the specificity was 46%. 3) One hundred percent of group A patients had CAD and 54% of them had multivessel disease, 75% of group B had CAD and 27% of them had multivessel disease, and 33% of group C had CAD and 10% of them had multivessel disease. 4) There were no significant differences in the siite of stenotic lesion and degree of stenosis according to ETS in the patients with single vessel disease. 5) There were no significant differences in left ventricular ejection fraction and left ventricular end-diastolic pressure among three groups.
CONCLUSION
Exercise treadmill score is useful in predicting the presence and severity of CAD and that low ETS less than -11 may be an indicator of multivessel coronary disease.