Systematic review, meta-analysis and economic modelling of ...
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Systematic review, meta-analysis and economic modelling of ... Systematic review, meta-analysis and economic modelling of ...

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Assessment of diagnostic and prognostic accuracyTABLE 29 Summary of characteristics of exercise ECG studiesPaper n tested n follow-upMean age(years) Sex Inclusions ExclusionsDuration offollow-up MACEAmsterdam 1000 1000 50 520/10002002 138 maleResting ECG that was normal,only minor ST-T changesECG ischaemia or infarction 30 days Revascularisation,deathDe Filippi 2001 139 125 110 48 59/125 Low probability (≤ 7%) of acuteMI (Goldman et al., 152 low risk),ability to exercise, no priorhistory of CADECG ischaemia Median 374 days Revascularisation,death, MIDiercks 958 742 43 522/9582000 140 maleNon-diagnostic ECG for MI andischaemiaECG MI 12 months Revascularisation,shock, cardiacdeath, MI, HF,life-threateningarrhythmiaGomez1996 141 50 50 50 31/50 male Low risk > 7% probability of having anAMI (Goldman et al., 152 highrisk), ECG ischaemia, arrhythmia,HF, high blood pressure30 days Death, MIGoodacre 422 422 54 461/7062005 142 maleAcute chest pain, normal ornon-diagnostic ECG, no priorhistory of CADRecent diagnostic testing forcoronary heart disease, unableto exercise6 months Revascularisation,MI, deathJeetley154 151 60 87/1542006 143 maleNormal or non-diagnostic ECG,and ≥ 2 risk factors for CADECG ischaemia, contraindicationsto perform exercise testing8.5 months Revascularisation,MI, deathKerns 1993 144 32 32 35 20/32 male Atypical chest pain, normalECG, low-risk CADModerate suspicion of AMIor ischaemic heart disease,high risk, history of CAD,physical limitations precludingperformance of ETT6 months MI, deathKirk 1998 145 212 200 49 121/212maleLow-risk patients (based onelectrocardiographic andclinical findings)ECG suggestive of MI orischaemia, unable to perform atreadmill test30 days Revascularisation76NIHR Journals Library

DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 1Paper n tested n follow-upMean age(years) Sex Inclusions ExclusionsDuration offollow-up MACELewis 1994 146 93 82 50 48/93 male Low-risk patients (based onelectrocardiographic andclinical findings).ECGs diagnostic of infarction orischaemia6–37 months MIPolananczyk 276 276 59 130/2761998 147 maleLower risk for major cardiaceventsHigh risk (Goldman et al). ECGischaemia6 months PTCA, CABG or MIRamakrishna 125 125 55 71/1252005 148 maleIntermediate-risk profile forcardiovascular eventsECG ischaemia 6 months MI or HFSarullo 190 190 57 127/1902000 149 maleLow-risk patients (Pryormonogram)ECG diagnostic of infarction orischaemiaMinimum12 monthsCardiac death, MI,PTCA, CABGTsakonis 1991 150 28 28 45 23/28 male Unstable CAD. No prior cardiachistory, normal or near normalECG, able to exercise on atreadmillPrior cardiac history, ECGischaemia1–12 months Cardiac eventsAMI, acute myocardial infarction; HF, heart failure; PTCA, percutaneous transluminal coronary angioplasty.© Queen’s Printer and Controller of HMSO 2013. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of Statefor Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journalsprovided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton SciencePark, Southampton SO16 7NS, UK.77

Assessment <strong>of</strong> diagnostic <strong>and</strong> prognostic accuracyTABLE 29 Summary <strong>of</strong> characteristics <strong>of</strong> exercise ECG studiesPaper n tested n follow-upMean age(years) Sex Inclusions ExclusionsDuration <strong>of</strong>follow-up MACEAmsterdam 1000 1000 50 520/10002002 138 maleResting ECG that was normal,only minor ST-T changesECG ischaemia or infarction 30 days Revascularisation,deathDe Filippi 2001 139 125 110 48 59/125 Low probability (≤ 7%) <strong>of</strong> acuteMI (Goldman et al., 152 low risk),ability to exercise, no priorhistory <strong>of</strong> CADECG ischaemia Median 374 days Revascularisation,death, MIDiercks 958 742 43 522/9582000 140 maleNon-diagnostic ECG for MI <strong>and</strong>ischaemiaECG MI 12 months Revascularisation,shock, cardiacdeath, MI, HF,life-threateningarrhythmiaGomez1996 141 50 50 50 31/50 male Low risk > 7% probability <strong>of</strong> having anAMI (Goldman et al., 152 highrisk), ECG ischaemia, arrhythmia,HF, high blood pressure30 days Death, MIGoodacre 422 422 54 461/7062005 142 maleAcute chest pain, normal ornon-diagnostic ECG, no priorhistory <strong>of</strong> CADRecent diagnostic testing forcoronary heart disease, unableto exercise6 months Revascularisation,MI, deathJeetley154 151 60 87/1542006 143 maleNormal or non-diagnostic ECG,<strong>and</strong> ≥ 2 risk factors for CADECG ischaemia, contraindicationsto perform exercise testing8.5 months Revascularisation,MI, deathKerns 1993 144 32 32 35 20/32 male Atypical chest pain, normalECG, low-risk CADModerate suspicion <strong>of</strong> AMIor ischaemic heart disease,high risk, history <strong>of</strong> CAD,physical limitations precludingperformance <strong>of</strong> ETT6 months MI, deathKirk 1998 145 212 200 49 121/212maleLow-risk patients (based onelectrocardiographic <strong>and</strong>clinical findings)ECG suggestive <strong>of</strong> MI orischaemia, unable to perform atreadmill test30 days Revascularisation76NIHR Journals Library

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