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DOI: 10.1055/s-2006-941723
© Georg Thieme Verlag KG Stuttgart · New York
Prädiktiver Wert eines Ischämietests bei Männern und Frauen mit stabiler Angina pectoris im Klinikalltag
Ergebnisse des Herzkatheter-Registers der ALKK Predictive value of a stress test in men and women with stable angina pectoris in clinical practiceResults of the quality control registry of the Working Party of Senior Hospital CardiologistsPublication History
eingereicht: 22.7.2005
akzeptiert: 2.2.2006
Publication Date:
09 May 2006 (online)

Zusammenfassung
Hintergrund und Fragestellung: Frauen unterscheiden sich von Männern hinsichtlich der Symptomatik einer koronaren Herzkrankheit (KHK) und der Aussagekraft nichtinvasiver Testverfahren. Die Untersuchung geht dem prädiktiven Wert eines Ischämietests für die Diagnose einer signifikanten KHK (≥ 50 % Stenose) bei Männern und Frauen mit stabiler Angina pectoris im Klinikalltag nach.
Patienten und Methodik: Im Jahr 2002 wurden an 99 Kliniken 143 848 konsekutive Patienten mit diagnostischer Koronarangiographie in das prospektive Herzkatheterregister der ALKK aufgenommen. In diese Untersuchung wurden Patienten mit Ischämietest und stabiler Angina pectoris CCS I-III (n = 27 387; 20,4 %) eingeschlossen, 10 911 (39,8 %) davon waren Frauen. 70,6 % der Frauen und 72,2 % der Männer hatten einen positiven Ischämietest.
Ergebnisse: Eine signifikante KHK hatten 46,1 % der Frauen gegenüber 71,5 % der Männer mit positivem Ischämietest und stabiler Angina (p < 0,001). Diabetes mellitus erhöhte die Prävalenz der KHK bei Frauen und Männern mit positivem Test auf 65,5 bzw. 80,5 %, die CCS-Klasse III auf 63,3 % bzw. 85,8 %.
Folgerungen: In der klinischen Praxis zeigt ein positiver Ischämietest bei Frauen mit stabiler Angina signifikant seltener als bei Männern eine klinisch relevante KHK an; der sehr niedrige positiv prädiktive Wert von 46,1 % bei Frauen unterstreicht die Bedeutung zusätzlicher klinischer Risikoindikatoren wie Diabetes und Anginasymptomatik vor der Entscheidung zur Invasivdiagnostik bei Verdacht auf eine KHK.
Summary
Background and objective: Symptoms of coronary artery disease (CAD) and the accuracy of non-invasive tests differ between men and women. This study sought to evaluate the difference between the predictive value of a stress test in clinical practice for the diagnosis of significant coronary heart disease (CHD: stenosis > 50%) between women and men with stable angina.
Patients and methods: 143,848 consecutive patients undergoing diagnostic coronary angiography at 99 hospitals during 2002 were included in the prospective cardiac catheter registry of the Woring Party of Senior Hospital Cardiologists (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte [ALKK]). All patients with stress test and stable angina CCS class I-III (n=27387;20,4%) were included, 10,911 (39,8%) of them female. 70,6% of women and 73,2% of men had a positive stress test.
Results: In 46,1% of women and 71,5% of men with positive test and stable angina had relevant CHD (p<0,001). Diabetes increased the prevalence of CHD in patients with a positive test both in women (65,5%) and men (80,5%), with CCS class III angina to 63,3% and 85,8%, respectively.
Conclusions: In clinical practice a positive stress test in women with stable angina is associated significantly less often with clinically relevant CHD than in men. The low positive predictive value of 46,1% underlines the need for additional clinical features like diabetes or cardiac symptoms (CCS class) before invasive diagnosis is performed.
Schlüsselwörter
Koronare Herzkrankheit (KHK) - Angina pectoris - Ischämiediagnostik - Koronarangiographie - Frauen - nichtinvasive Diagnostik
Key words
coronary artery disease (CAD) - stable angina - stress test - coronaroangiography - women - noninvasive diagnostics
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Priv.-Doz. Dr. Uwe Zeymer
Herzzentrum Ludwigshafen, Medizinische Klinik B
Bremserstraße 79
67063 Ludwigshafen
Phone: 0621/5034045
Fax: 0621/5034002
Email: Uwe.Zeymer@t-online.de