Athens QRS score as a predictor of coronary artery disease in patients with chest pain and normal exercise stress test

Background-the diagnostic value of the athens qrs score to detect obstructive coronary artery disease cad in patients with otherwise normal exercise stress test remains unclear. methods and results-we analyzed 458 patients who underwent exercise stress test with or without myocardial perfusion imaging within 2 months of coronary angiography from 2008 to 2011. patients (n=173) with abnormal stress test based on st segment criteria were excluded. the athens qrs score ≤5 was defined as abnormal. in our study cohort,285 patients met the inclusion criteria and were divided into 2 groups: low athens qrs score (lqrs,n=56),with qrs score ≤5 and normal athens qrs score normal athens qrs score,n=229),with qrs score > 5. the presence of single-vessel and multivessel obstructive cad was higher in lqrs than in normal athens qrs score patients (47% versus 7.5% and 30% versus 3.8%,respectively,all p < 0.001). logistic regression analysis showed that the likelihood of cad was strongly and independently associated with lqrs (odds ratio=36.81,95% ci: 10.77-120.47),diabetes (odds ratio=6.49,95% ci: 2.41-17.49),lower maximum heart rate (odds ratio=0.92,95% ci: 0.88-0.95,all p < 0.001),and older age (odds ratio=1.93,ci: 1.88-1.97,p=0.002). conclusions-in a clinical cohort of patients with chest pain and normal exercise stress test,lqrs score is a strong independent predictor of presence of cad. lqrs patients have a 6-fold higher prevalence of cad and may warrant further evaluation even with reassuring exercise stress test. © 2016 the authors.