20th Century methods in 2015 – time to re-look?

Abstract

Background: Are Pre Test Probability (PTP), and Duke Treadmill Score (DTS) used together still an ‘appropriate’ method for selecting patients for angiography referral, or discharge, following outpatient exercise tolerance tests (ETT)? Methods: Outpatients who were referred for coronary angiogram following an ETT from 1 Jan 2014 – 31st Dec 2014 were assessed. PTP and DSwere calculated. Discharged patients from 1 Jan -Feb 28th 2014 (1 year following ETT)were reviewed. Results:Total=54 (Men41/Woman13),Age (44-82/48-75), High PTP and High risk DTS (12/0), High PTP and Intermediate Risk DTS (23/3), High PTP and Low Risk DTS (1/0), Intermediate PTP andHighRiskDTS (1/0), Intermediate PTP and Intermediate Risk DTS (4/8), Intermediate PTP and Low Risk DTS (0/2). 89 discharged with low to intermediate PTP and DTS. Conclusion: Most patients with intermediate to high PTP and DTS angiography demonstrated ischaemic heart disease to some degree (number = 28 of 39); 1 had muscle bridging, 2 had global TIMI II flow, 8 were normal. Men with a high PTP and intermediate to high risk DTS were more likely to have ischaemic heart disease (IHD). Women with an intermediate PTP and DTS were more likely to have IHD. At one year follow-upnoneof thepatientsdischargedhad significant cardiac events. It is safe to discharge patients following ETT with both a low PTP and DTS. While both tools have limitations, when used together they did demonstrate they are an appropriate method for selecting patients for angiography referral or discharge from service.