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目的:评价平板运动试验Duke评分(DTS)对冠心病危险分层的实用性。方法:选择151例胸痛患者行心电图平板运动试验(ETT)和冠状动脉造影检查,按DTS分为DTS中危组(DTS-10～+4,n=65)和DTS高危组(DTS≤-11,n=86),将其结果进行对照分析。用交叉表卡方检验的方法分析Duke评分预测有意义(至少1支≥50狭窄)和重度(3支或左主干)冠状动脉病变的价值。结果:在DTS高危组中ST段偏移、ST/HR-index、限制性心绞痛例数和年平均病死率均明显高于DTS中危组;而无心绞痛例数、运动时间和运动负荷量明显低于DTS中危组(P均<0.001),差异均有统计学意义。随冠状动脉病变严重程度的加重DTS高危组病例数显著增多,冠状动脉造影阳性有意义病变(至少1支≥50狭窄)者DTS中危组44例(67.7),DTS高危组80例(93.0);重度病变(3支或左主干狭窄)DTS中危组9例(13.8),DTS高危组39例(45.3)。年平均病死率DTS中危组为(2.9±1.1)、DTS高危组为(6.8±1.6),两组相比差异均有统计学意义(P均<0.001)。结论:DTS不仅提供准确的预后数据,而且能预测冠状动脉病变程度,应用该评分可以更好的进行冠心病危险评估。
PURPOSE: To evaluate the usefulness of treadmill exercise test Duke score (DTS) in risk stratification of coronary heart disease. Methods: One hundred and fifteen patients with chest pain were examined by electrocardiogram treadmill test (ETT) and coronary angiography. DTS was divided into DTS moderate risk group (DTS-10 ~ + 4, n = 65) and DTS high risk group , n = 86), the results of the comparative analysis. The value of the Duke score predictive of significance (at least 1 ≥50 stenosis) and severe (3-leg or left-sided) coronary lesions was analyzed by crossover chi-square test. Results: The ST segment deviation, ST / HR-index, the number of patients with restrictive angina and the average annual mortality in DTS high risk group were significantly higher than those in DTS moderate risk group, but no cases of angina pectoris, exercise time and exercise load were significantly Lower than the DTS moderate risk group (P <0.001), the differences were statistically significant. The number of high-risk DTS patients increased significantly with the severity of coronary artery disease (DTS), 44 (67.7%) in the DTS moderate-risk group and 80 (93.0%) in the DTS high-risk group with positive coronary angiography (at least 1 ≥50 stenosis) ; 9 cases (13.8) in DTS moderate-risk group and 39 cases (45.3%) in DTS high-risk group for severe lesions (3 or left main stenosis). The annual average mortality was (2.9 ± 1.1) in DTS middle-risk group and (6.8 ± 1.6) in DTS high-risk group, with significant difference between the two groups (all P <0.001). CONCLUSION: DTS not only provides accurate prognostic data but also predicts the extent of coronary artery disease, which can be used to better assess the risk of coronary heart disease.