Ruling Out CHD in Primary Care – Diagnostic Accuracy of Gender Specific Scores

DOI: 10.3238/zfa.2010.0315

german translation / full article

Erika Baum, Norbert Donner-Banzhoff, Stefan Bösner, Jörg Haasenritter, Maren Abu Hani, Heidi Keller, Andreas C. Sönnichsen, Konstantinos Karatolios, Juergen R. Schaefer

Keywords: chest pain myocardial ischemia sex characteristics sensitivity and specificity decision making

Background: Diagnosis of coronary heart disease (CHD) is challenging for general practitioners (GPs). We analysed the diagnostic accuracy of gender specific CHD scores compared to the Marburg CHD score in patients presenting with chest pain.

Method: In 1199 consecutively recruited chest pain patients, GPs noted symptoms and signs and we collected follow up data. An independent reference panel decided about the most likely diagnosis at the time of recruitment. Based on the results of multivariate analysis, we constructed gender specific CHD scores and calculated the area under the Receiver Operating Characteristics (ROC) curve (AUC).

Results: The CHD score for women contained 4, the CHD score for men 5 components. The AUC (score women) was 0.83 (0.78-0.87), the AUC (score men) 0.88 (0.84-0.92). The general (Marburg) CHD Score had for women an AUC of 0.84 (0.77-0.90), for men an AUC of 0.89 (0.85-0.93).

Conclusion: Gender specific scores showed in comparison to the Marburg CHD score similar diagnostic validity. For the GP they do not offer an additional value for excluding CHD in patients presenting with chest pain.

(State: 14.09.2010)

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