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Positive Predictive Value of Noninvasive Stress Testing Is Poor in the Real World.
Critical Pathways in Cardiology
|February 13, 2018
Summary
The positive predictive value (PPV) of noninvasive stress tests (NIST) for detecting coronary artery disease is only 36.4%. Older age, male sex, and more cardiac risk factors increase NIST
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Practice
Background:
- Abnormal noninvasive stress test (NIST) findings do not consistently indicate significant coronary artery disease.
- The real-world positive predictive value (PPV) of NIST is not well-established.
Purpose of the Study:
- To determine the PPV of NIST in a US community hospital.
- To identify factors influencing the PPV of NIST.
Main Methods:
- Retrospective analysis of 324 patients undergoing invasive coronary angiography after a positive NIST.
- Stratification by age, body mass index, and stress test modality.
- Multivariable logistic regression to identify determinants of PPV.
Main Results:
- Overall NIST PPV was 36.4%.
- Older age, male sex, and higher cardiac risk factors were associated with increased PPV.
- Stress echocardiogram showed higher PPV (71%) than myocardial perfusion imaging (35%).
- Younger, female, and obese patients had lower PPV.
Conclusions:
- The overall PPV of NIST is poor in clinical practice.
- Patient demographics and comorbidities significantly impact NIST accuracy.
- Test modality choice may influence diagnostic yield.
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