Explainable advanced electrocardiography has a high negative predictive value for ruling out significant coronary artery disease on cardiovascular computed tomography
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BACKGROUND
Advanced electrocardiography (A-ECG) has been used to improve the diagnostic performance of the ECG in a number of cardiac disease states. We hypothesised that A-ECG can improve the diagnostic assessment of intermediate risk chest pain by optimising an A-ECG score for significant coronary artery disease (CAD) by cardiovascular computed tomography (CCT).
METHODS
Participants attending an outpatient rapid access chest pain clinic underwent a 12-lead ECG and CCT. Significant CAD was defined as luminal stenosis >50%. Multivariable logistic regression was performed using measures from the conventional ECG, derived vectorcardiography, and singular value decomposition measures of waveform complexity.
RESULTS
Of included patients (n=171, 60% male, age 59±13 years), 37 (22%) had >50% stenosis in at least one coronary artery, with single, double, or triple vessel disease in 38%, 38%, and 24%, respectively. A four parameter A-ECG score to detect significant CAD had an area under the receiver operating characteristic curve [95% confidence interval] of 0.87 [0.78–0.94], sensitivity 89 [69–97]%, specificity 82 [68-94]%, positive predictive value 55 [43–78]%, negative predictive value 96 [92–99]%, positive likelihood ratio 4.6 [2.9–13.1] and inverse negative likelihood ratio 6.4 [2.9–27.2].
CONCLUSION
A-ECG can rule out significant CAD on CCT with a high negative predictive value and overall good diagnostic performance. This supports the use of A-ECG to screen patients in a chest pain clinic setting who would benefit from further testing or not.
