Use of a simple clinical score to predict prognosis of patients with normal or mildly abnormal resting electrocardiographic findings undergoing evaluation for coronary artery disease

Kheng Thye Ho, Todd D. Miller, David O. Hodge, Kent R Bailey, Raymond J Gibbons

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35 Citations (Scopus)

Abstract

Objective: To determine whether a simple clinical score, which was shown previously to predict the likelihood of severe coronary artery disease (CAD) in patients referred for coronary angiography, could predict prognosis in a separate cohort of patients with normal or mildly abnormal findings on their resting electrocardiogram (ECG) who were undergoing noninvasive evaluation for possible CAD. Patients and Methods: The study group included 2255 symptomatic patients with normal (n=1466) or mildly abnormal (nonspecific ST-T-wave abnormalities; n=789) findings on their resting ECG who were referred for exercise thallium testing between 1989 and 1991. Follow-up was 94% complete at a mean ± SD duration of 6.9±1.5 years. The clinical score, which ranged from 0 (lowest risk) to 10 (highest risk), was calculated by awarding 1 point each for male sex, history of myocardial infarction, typical angina, diabetes mellitus, insulin use, and each decade of age older than 40 years. Results: In each ECG group, the clinical score was a significant predictor of cardiac death, nonfatal myocardial infarction, or late revascularization, considered individually or combined, unadjusted or with adjustment for age. Most patients had a score lower than 5; these patients had an excellent 5-year cardiac survival rate (99.7% for the normal ECG findings group and 98.8% for the ST-T-wave abnormalities group). The small subset of patients with a score higher than 5 had a much lower 5-year survival rate (92.3% for the 8% of patients with normal ECG findings and 86.6% for the 14% of patients with ST-T-wave abnormalities). For patients with a score of 5, the 5-year survival rate was 97.7% for the normal ECG findings group and 95.9% for the ST-T-wave abnormalities group. Conclusion: In symptomatic patients with known or suspected CAD and normal or mildly abnormal resting ECG findings, this simple, easily computed clinical score is a useful and valid tool to help determine prognosis.

Original languageEnglish (US)
Pages (from-to)515-521
Number of pages7
JournalMayo Clinic Proceedings
Volume77
Issue number6
StatePublished - 2002

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Coronary Artery Disease
Electrocardiography
Survival Rate
Myocardial Infarction
Thallium
Coronary Angiography
Diabetes Mellitus
Exercise
Insulin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{4590201a26db4d0cbcbbbf572fd2e2de,
title = "Use of a simple clinical score to predict prognosis of patients with normal or mildly abnormal resting electrocardiographic findings undergoing evaluation for coronary artery disease",
abstract = "Objective: To determine whether a simple clinical score, which was shown previously to predict the likelihood of severe coronary artery disease (CAD) in patients referred for coronary angiography, could predict prognosis in a separate cohort of patients with normal or mildly abnormal findings on their resting electrocardiogram (ECG) who were undergoing noninvasive evaluation for possible CAD. Patients and Methods: The study group included 2255 symptomatic patients with normal (n=1466) or mildly abnormal (nonspecific ST-T-wave abnormalities; n=789) findings on their resting ECG who were referred for exercise thallium testing between 1989 and 1991. Follow-up was 94{\%} complete at a mean ± SD duration of 6.9±1.5 years. The clinical score, which ranged from 0 (lowest risk) to 10 (highest risk), was calculated by awarding 1 point each for male sex, history of myocardial infarction, typical angina, diabetes mellitus, insulin use, and each decade of age older than 40 years. Results: In each ECG group, the clinical score was a significant predictor of cardiac death, nonfatal myocardial infarction, or late revascularization, considered individually or combined, unadjusted or with adjustment for age. Most patients had a score lower than 5; these patients had an excellent 5-year cardiac survival rate (99.7{\%} for the normal ECG findings group and 98.8{\%} for the ST-T-wave abnormalities group). The small subset of patients with a score higher than 5 had a much lower 5-year survival rate (92.3{\%} for the 8{\%} of patients with normal ECG findings and 86.6{\%} for the 14{\%} of patients with ST-T-wave abnormalities). For patients with a score of 5, the 5-year survival rate was 97.7{\%} for the normal ECG findings group and 95.9{\%} for the ST-T-wave abnormalities group. Conclusion: In symptomatic patients with known or suspected CAD and normal or mildly abnormal resting ECG findings, this simple, easily computed clinical score is a useful and valid tool to help determine prognosis.",
author = "Ho, {Kheng Thye} and Miller, {Todd D.} and Hodge, {David O.} and Bailey, {Kent R} and Gibbons, {Raymond J}",
year = "2002",
language = "English (US)",
volume = "77",
pages = "515--521",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
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T1 - Use of a simple clinical score to predict prognosis of patients with normal or mildly abnormal resting electrocardiographic findings undergoing evaluation for coronary artery disease

AU - Ho, Kheng Thye

AU - Miller, Todd D.

AU - Hodge, David O.

AU - Bailey, Kent R

AU - Gibbons, Raymond J

PY - 2002

Y1 - 2002

N2 - Objective: To determine whether a simple clinical score, which was shown previously to predict the likelihood of severe coronary artery disease (CAD) in patients referred for coronary angiography, could predict prognosis in a separate cohort of patients with normal or mildly abnormal findings on their resting electrocardiogram (ECG) who were undergoing noninvasive evaluation for possible CAD. Patients and Methods: The study group included 2255 symptomatic patients with normal (n=1466) or mildly abnormal (nonspecific ST-T-wave abnormalities; n=789) findings on their resting ECG who were referred for exercise thallium testing between 1989 and 1991. Follow-up was 94% complete at a mean ± SD duration of 6.9±1.5 years. The clinical score, which ranged from 0 (lowest risk) to 10 (highest risk), was calculated by awarding 1 point each for male sex, history of myocardial infarction, typical angina, diabetes mellitus, insulin use, and each decade of age older than 40 years. Results: In each ECG group, the clinical score was a significant predictor of cardiac death, nonfatal myocardial infarction, or late revascularization, considered individually or combined, unadjusted or with adjustment for age. Most patients had a score lower than 5; these patients had an excellent 5-year cardiac survival rate (99.7% for the normal ECG findings group and 98.8% for the ST-T-wave abnormalities group). The small subset of patients with a score higher than 5 had a much lower 5-year survival rate (92.3% for the 8% of patients with normal ECG findings and 86.6% for the 14% of patients with ST-T-wave abnormalities). For patients with a score of 5, the 5-year survival rate was 97.7% for the normal ECG findings group and 95.9% for the ST-T-wave abnormalities group. Conclusion: In symptomatic patients with known or suspected CAD and normal or mildly abnormal resting ECG findings, this simple, easily computed clinical score is a useful and valid tool to help determine prognosis.

AB - Objective: To determine whether a simple clinical score, which was shown previously to predict the likelihood of severe coronary artery disease (CAD) in patients referred for coronary angiography, could predict prognosis in a separate cohort of patients with normal or mildly abnormal findings on their resting electrocardiogram (ECG) who were undergoing noninvasive evaluation for possible CAD. Patients and Methods: The study group included 2255 symptomatic patients with normal (n=1466) or mildly abnormal (nonspecific ST-T-wave abnormalities; n=789) findings on their resting ECG who were referred for exercise thallium testing between 1989 and 1991. Follow-up was 94% complete at a mean ± SD duration of 6.9±1.5 years. The clinical score, which ranged from 0 (lowest risk) to 10 (highest risk), was calculated by awarding 1 point each for male sex, history of myocardial infarction, typical angina, diabetes mellitus, insulin use, and each decade of age older than 40 years. Results: In each ECG group, the clinical score was a significant predictor of cardiac death, nonfatal myocardial infarction, or late revascularization, considered individually or combined, unadjusted or with adjustment for age. Most patients had a score lower than 5; these patients had an excellent 5-year cardiac survival rate (99.7% for the normal ECG findings group and 98.8% for the ST-T-wave abnormalities group). The small subset of patients with a score higher than 5 had a much lower 5-year survival rate (92.3% for the 8% of patients with normal ECG findings and 86.6% for the 14% of patients with ST-T-wave abnormalities). For patients with a score of 5, the 5-year survival rate was 97.7% for the normal ECG findings group and 95.9% for the ST-T-wave abnormalities group. Conclusion: In symptomatic patients with known or suspected CAD and normal or mildly abnormal resting ECG findings, this simple, easily computed clinical score is a useful and valid tool to help determine prognosis.

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