Accuracy of ST/heart rate index in the diagnosis of coronary artery disease.

The accuracy of ST/heart rate (ST HR) index was evaluated in patients presenting for exercise electrocardiography with suspected coronary disease. In all, 420 patients (235 men and 185 women) with normal electrocardiograms at rest underwent exercise testing, followed within 3 months by coronary angiography. The sensitivity and specificity for standard ST criteria (greater than or equal to 1 mm horizontal or downsloping depression) were 48% (78 of 162) and 81% (208 of 258), respectively. An ST HR-index threshold of 1.86 microV/beta/min had the exact same specificity with a sensitivity of 44% (71 of 162; p = not significant). Consideration of greater than or equal to 1.5 mm upsloping depression had no significant impact on the aforementioned results. Using multivariate logistic regression analysis, age, sex, symptoms, cigarette smoking, diabetes mellitus, qualitative ST slope, rate-pressure product, METs achieved and exercise angina were evaluated with and without ST HR index and ST depression. According to this analysis, age, sex, symptoms and ST slope were good predictors of presence or absence of disease. Neither ST HR index nor ST depression had significance in the multivariate analysis. However, when a separate analysis was performed in men and women, the 2 quantitative ST variables showed significance in men, but not in women. Comparisons of discriminative accuracy using receiver-operating characteristic curves demonstrated differences between men and women, but no difference between ST HR index and ST depression. Therefore, concerning questions of coronary disease diagnosis, consideration of ST HR index was not better than standard ST criteria, and added nothing to multivariate analysis of other available variables.