BACKGROUND: A diagnosis of unstable angina pectoris (UAP) often carries with it a decision to catheterize the patient promptly. However, UAP remains a clinical diagnosis, based mostly on a patient's clinical history and electrocardiogram (ECG) findings. OBJECTIVE: To evaluate whether the diagnosis of UAP is overused in patients referred for coronary arteriography. METHODS: Ninety-six patients with a diagnosis of UAP who were referred for invasive studies were re-examined clinically before catheterization. Coronarography was independently reviewed for correlation with clinical findings. RESULTS: Based on the patient's history and ECG changes, UAP was classified by two independent cardiologists as 'very likely' in 58% and 49%, 'possible' in 19% and 30%, and of 'low probability' in 23% and 21%, respectively. Patients with 'very likely' UAP had a high incidence of significant coronary lesions (87% and 96% for each cardiologist) and complex lesions by angiography (41% and 49%, respectively). Patients with a diagnosis of 'low probability' UAP had a low incidence of significant coronary lesions (55% for each cardiologist) and a very low incidence of complex angiographic lesions (5% for each cardiologist). Patients with 'possible' UAP had intermediate results. CONCLUSION: Because of a presumptive diagnosis of UAP, approximately 22% of all patients referred for coronarography have no clinical and/or ECG evidence for this diagnosis. The incidence of complex coronary lesions in this group is very low.
BACKGROUND: A diagnosis of unstable angina pectoris (UAP) often carries with it a decision to catheterize the patient promptly. However, UAP remains a clinical diagnosis, based mostly on a patient's clinical history and electrocardiogram (ECG) findings. OBJECTIVE: To evaluate whether the diagnosis of UAP is overused in patients referred for coronary arteriography. METHODS: Ninety-six patients with a diagnosis of UAP who were referred for invasive studies were re-examined clinically before catheterization. Coronarography was independently reviewed for correlation with clinical findings. RESULTS: Based on the patient's history and ECG changes, UAP was classified by two independent cardiologists as 'very likely' in 58% and 49%, 'possible' in 19% and 30%, and of 'low probability' in 23% and 21%, respectively. Patients with 'very likely' UAP had a high incidence of significant coronary lesions (87% and 96% for each cardiologist) and complex lesions by angiography (41% and 49%, respectively). Patients with a diagnosis of 'low probability' UAP had a low incidence of significant coronary lesions (55% for each cardiologist) and a very low incidence of complex angiographic lesions (5% for each cardiologist). Patients with 'possible' UAP had intermediate results. CONCLUSION: Because of a presumptive diagnosis of UAP, approximately 22% of all patients referred for coronarography have no clinical and/or ECG evidence for this diagnosis. The incidence of complex coronary lesions in this group is very low.
Authors: Sidney C Smith; Ted E Feldman; John W Hirshfeld; Alice K Jacobs; Morton J Kern; Spencer B King; Douglass A Morrison; William W O'neill; Hartzell V Schaff; Patrick L Whitlow; David O Williams; Elliott M Antman; Sidney C Smith; Cynthia D Adams; Jeffrey L Anderson; David P Faxon; Valentin Fuster; Jonathan L Halperin; Loren F Hiratzka; Sharon Ann Hunt; Alice K Jacobs; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel Journal: J Am Coll Cardiol Date: 2006-01-03 Impact factor: 24.094
Authors: B Pitt; D Waters; W V Brown; A J van Boven; L Schwartz; L M Title; D Eisenberg; L Shurzinske; L S McCormick Journal: N Engl J Med Date: 1999-07-08 Impact factor: 91.245
Authors: Jason W Ryan; Eric D Peterson; Anita Y Chen; Matthew T Roe; E Magnus Ohman; Christopher P Cannon; Peter B Berger; Jorge F Saucedo; Elizabeth R DeLong; Sharon-Lise Normand; Charles V Pollack; David J Cohen Journal: Circulation Date: 2005-11-07 Impact factor: 29.690
Authors: William E Boden; Robert A O'Rourke; Koon K Teo; Pamela M Hartigan; David J Maron; William J Kostuk; Merril Knudtson; Marcin Dada; Paul Casperson; Crystal L Harris; Bernard R Chaitman; Leslee Shaw; Gilbert Gosselin; Shah Nawaz; Lawrence M Title; Gerald Gau; Alvin S Blaustein; David C Booth; Eric R Bates; John A Spertus; Daniel S Berman; G B John Mancini; William S Weintraub Journal: N Engl J Med Date: 2007-03-26 Impact factor: 91.245
Authors: N R Every; C P Cannon; C Granger; D J Moliterno; F V Aguirre; J D Talley; J Booth; S Sapp; J J Ferguson Journal: J Am Coll Cardiol Date: 1998-08 Impact factor: 24.094