Abstract
Background: ETT has a sensitivity (68%) and specificity (77%) for angiographic coronary artery disease (CAD), leading to missed diagnoses as well as to false positive results. Advanced ECG (A-ECG) is a low-cost, software method for improving the diagnostic characteristics of traditional resting 12L-ECG. Methods: We retrospectively performed A-ECG analysis on the electronically stored, 10-sec resting 12L-ECG files of 58 patients with intermediate to high clinical suspicion of CAD who had positive ETT tests that prompted coronary angiography. A-ECG calls of ‘Disease’ versus ‘No Disease’ were made in a blinded and automated fashion on the stored data using a validated 6-parameter A-ECG score that combines results from certain conventional ECG parameters with those from T-wave complexity and derived 3-dimensional ECG. Results: Of the 58 patient 12L-ECGs, one was excluded due to noise and six due to other proven cardiac abnormalities found on echocardiography (e.g., LVH, systolic dysfunction). Resting A-ECG returned 42 ‘Disease’ and 9 ‘No Disease’ (e.g. Figure 1) calls with a sensitivity of 97.2% and specificity of 53% for the angiography results. By design in this retrospective study with known referral-bias, the positive ETT results were 71% sensitive and 0% specific for the same angiography results in the same patients. Conclusion: In this group of patients who underwent angiography prompted by positive ETT, the addition of A-ECG test to the ETT would have substantially increased overall specificity without statistically significantly compromising sensitivity. AECG would theoretically reduce unnecessary invasive coronary angiograms by 53%, with a cost savings of $528/A-ECG.
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