Dipyridamole electrocardiography test for the detection of severe coronary artery stenoses

To investigate the relationship between dipyridamole-induced ST depression and the severity of coronary artery stenosis, the dipyridamole injection test (D) at 0.568 mg/kg/4 min, and the symptom limited treadmill exercise test (T) were performed separately in 16 normal volunteers and 167 patients who underwent coronary arteriography [91 patients without myocardial infarction (non-MI group) and 76 patients with previous myocardial infarction (MI group)]. Standard 12-lead electrocardiogram and body surface mapping of 87 leads were recorded in both tests. None of the normal volunteers had significant ST depression (greater than or equal to 0.10 mV) in D or T. Regarding the non-MI group, D had as high an incidence of ST depression as T (83% vs 93%) in patients with maximal coronary stenosis greater than or equal to 90%, while in those with maximum coronary stenosis less than 90%, D had a lower incidence of ST depression than T (16% vs 48%, p less than 0.01). For the MI group, the incidence of ST depression was compared to the maximal coronary artery stenosis supplying the non-infarcted area. In patients with maximal coronary artery stenosis greater than or equal to 90%, D had as high an incidence of ST depression as T (71% vs 64%). While, D had a lower incidence of ST depression than T (19% vs 35%, p less than 0.05) in those with maximum coronary artery stenosis less than 90%. For the diagnosis of coronary artery stenosis of greater than or equal to 90%, D had as high sensitivity (non-MI group, 82% vs 93%; MI group, 71% vs 64%) and higher specificity (non-MI group, 84% vs 52%, p less than 0.01; MI group, 81% vs 65%, p less than 0.05) compared with T. This study demonstrated that dipyridamole ECG is a sensitive and specific test to detect severe coronary artery stenosis.