NONINVASIVE DIAGNOSIS OF CORONARY HEART-DISEASE IN WOMEN - ST-SEGMENT ANALYSIS ON 24-HOUR ECG MONITORING OR EXERCISE ECG

The diagnostic value of an exercise ECG in women with the clinical symptoms of stable angina is limited because of its low accuracy in demonstrating coronary heart disease. A study of ambulatory patients was undertaken, involving 143 men and 29 women (mean age 55 [37-70] years), to determine whether ST-segment analysis of the 24-hour ECG gives better results, the coronary arteriogram providing the standard of comparison. 24-hour monitoring and the exercise ECG gave similar diagnostic results (66% vs 67%) in the 143 men. But in the 29 women 24-hour monitoring was diagnostically superior to the exercise ECG (76% vs 45%; P < 0.01), as a result of a significantly higher specificity (64% vs 29%; P < 0.05) and a tendency towards higher sensitivity (87% vs 60%; P = 0.13). As expected, the accuracy of the exercise ECG was thus lower in women than in men (P < 0.05). There were no significant gender-specific differences for accuracy of 24-hour monitoring (76% in women, 66% in men; P < 0.15). These data indicate that in women ST-segment analysis of the 24-hour ECG is better than the exercise ECG for demonstrating coronary heart disease.