Diagnostic accuracy of nitroglycerine as a 'test of treatment' for cardiac chest pain: A systematic review

Katherine Grailey, Paul P. Glasziou

Research output: Contribution to journalReview articleResearchpeer-review

5 Citations (Scopus)

Abstract

To determine the accuracy of using nitroglycerine as a 'test of treatment' in the diagnosis of cardiac chest pain we undertook a systematic review of studies of diagnostic accuracy. Databases searched included PubMed, Cochrane Database, Google Scholar, Science Citation Index, EMBASE and manual searching of bibliographies of known primary and review articles. Studies were included if sublingual nitroglycerine was the index test, its effect on the patient's pain score was recorded and the reference test was performed on at least 80% of patients. The data from the five papers were used to form 2x2 contingency tables. Five eligible studies were found, all in the acute setting (although one paper collected its data in the follow-up setting, all patients had acute presentations). The sensitivity ranged from 35% to 92% and the specificity from 12% to 63%. However, in all but one paper the Youden indices were close to zero suggesting that the response to nitroglycerine is not useful as a diagnostic test. The combined sensitivity was 0.52 (95% CI 0.48 to 0.56) and combined specificity was 0.49 (95% CI 0.46 to 0.52). The diagnostic OR from the combined studies was 1.2 (95% CI 0.97 to 1.5), which is not significantly different from 1. In the acute setting, nitroglycerine is not a reliable test of treatment for use in the diagnosis of coronary artery disease. However, further studies are needed to determine the diagnostic accuracy of nitroglycerine for recurrent exertional chest pain.

Original languageEnglish
Pages (from-to)173-176
Number of pages4
JournalEmergency Medicine Journal
Volume29
Issue number3
DOIs
Publication statusPublished - Mar 2012

Fingerprint

Nitroglycerin
Chest Pain
Databases
Therapeutics
Bibliography
Routine Diagnostic Tests
PubMed
Coronary Artery Disease
Pain

Cite this

@article{40d336406aca4f9fa096b060535d3b7b,
title = "Diagnostic accuracy of nitroglycerine as a 'test of treatment' for cardiac chest pain: A systematic review",
abstract = "To determine the accuracy of using nitroglycerine as a 'test of treatment' in the diagnosis of cardiac chest pain we undertook a systematic review of studies of diagnostic accuracy. Databases searched included PubMed, Cochrane Database, Google Scholar, Science Citation Index, EMBASE and manual searching of bibliographies of known primary and review articles. Studies were included if sublingual nitroglycerine was the index test, its effect on the patient's pain score was recorded and the reference test was performed on at least 80{\%} of patients. The data from the five papers were used to form 2x2 contingency tables. Five eligible studies were found, all in the acute setting (although one paper collected its data in the follow-up setting, all patients had acute presentations). The sensitivity ranged from 35{\%} to 92{\%} and the specificity from 12{\%} to 63{\%}. However, in all but one paper the Youden indices were close to zero suggesting that the response to nitroglycerine is not useful as a diagnostic test. The combined sensitivity was 0.52 (95{\%} CI 0.48 to 0.56) and combined specificity was 0.49 (95{\%} CI 0.46 to 0.52). The diagnostic OR from the combined studies was 1.2 (95{\%} CI 0.97 to 1.5), which is not significantly different from 1. In the acute setting, nitroglycerine is not a reliable test of treatment for use in the diagnosis of coronary artery disease. However, further studies are needed to determine the diagnostic accuracy of nitroglycerine for recurrent exertional chest pain.",
author = "Katherine Grailey and Glasziou, {Paul P.}",
year = "2012",
month = "3",
doi = "10.1136/emj.2010.103994",
language = "English",
volume = "29",
pages = "173--176",
journal = "Journal of Accident and Emergency Medicine",
issn = "1472-0205",
publisher = "BMJ Publishing Group",
number = "3",

}

Diagnostic accuracy of nitroglycerine as a 'test of treatment' for cardiac chest pain : A systematic review. / Grailey, Katherine; Glasziou, Paul P.

In: Emergency Medicine Journal, Vol. 29, No. 3, 03.2012, p. 173-176.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Diagnostic accuracy of nitroglycerine as a 'test of treatment' for cardiac chest pain

T2 - A systematic review

AU - Grailey, Katherine

AU - Glasziou, Paul P.

PY - 2012/3

Y1 - 2012/3

N2 - To determine the accuracy of using nitroglycerine as a 'test of treatment' in the diagnosis of cardiac chest pain we undertook a systematic review of studies of diagnostic accuracy. Databases searched included PubMed, Cochrane Database, Google Scholar, Science Citation Index, EMBASE and manual searching of bibliographies of known primary and review articles. Studies were included if sublingual nitroglycerine was the index test, its effect on the patient's pain score was recorded and the reference test was performed on at least 80% of patients. The data from the five papers were used to form 2x2 contingency tables. Five eligible studies were found, all in the acute setting (although one paper collected its data in the follow-up setting, all patients had acute presentations). The sensitivity ranged from 35% to 92% and the specificity from 12% to 63%. However, in all but one paper the Youden indices were close to zero suggesting that the response to nitroglycerine is not useful as a diagnostic test. The combined sensitivity was 0.52 (95% CI 0.48 to 0.56) and combined specificity was 0.49 (95% CI 0.46 to 0.52). The diagnostic OR from the combined studies was 1.2 (95% CI 0.97 to 1.5), which is not significantly different from 1. In the acute setting, nitroglycerine is not a reliable test of treatment for use in the diagnosis of coronary artery disease. However, further studies are needed to determine the diagnostic accuracy of nitroglycerine for recurrent exertional chest pain.

AB - To determine the accuracy of using nitroglycerine as a 'test of treatment' in the diagnosis of cardiac chest pain we undertook a systematic review of studies of diagnostic accuracy. Databases searched included PubMed, Cochrane Database, Google Scholar, Science Citation Index, EMBASE and manual searching of bibliographies of known primary and review articles. Studies were included if sublingual nitroglycerine was the index test, its effect on the patient's pain score was recorded and the reference test was performed on at least 80% of patients. The data from the five papers were used to form 2x2 contingency tables. Five eligible studies were found, all in the acute setting (although one paper collected its data in the follow-up setting, all patients had acute presentations). The sensitivity ranged from 35% to 92% and the specificity from 12% to 63%. However, in all but one paper the Youden indices were close to zero suggesting that the response to nitroglycerine is not useful as a diagnostic test. The combined sensitivity was 0.52 (95% CI 0.48 to 0.56) and combined specificity was 0.49 (95% CI 0.46 to 0.52). The diagnostic OR from the combined studies was 1.2 (95% CI 0.97 to 1.5), which is not significantly different from 1. In the acute setting, nitroglycerine is not a reliable test of treatment for use in the diagnosis of coronary artery disease. However, further studies are needed to determine the diagnostic accuracy of nitroglycerine for recurrent exertional chest pain.

UR - http://www.scopus.com/inward/record.url?scp=84857360355&partnerID=8YFLogxK

U2 - 10.1136/emj.2010.103994

DO - 10.1136/emj.2010.103994

M3 - Review article

VL - 29

SP - 173

EP - 176

JO - Journal of Accident and Emergency Medicine

JF - Journal of Accident and Emergency Medicine

SN - 1472-0205

IS - 3

ER -