BACKGROUND: Guidelines recommend noninvasive tests (NITs) to risk stratify and identify patients with higher likelihood of coronary artery disease (CAD) prior to elective coronary angiography. However, a high percentage of patients are found to have nonobstructive CAD. We aimed to understand the relationship between patient characteristics, NIT findings, and the likelihood of nonobstructive CAD. METHODS: Patients undergoing elective catheterization without history of CAD were identified from 1,128 hospitals in National Cardiovascular Data Registry's CathPCI Registry between July 2009 and December 2011. Noninvasive tests included stress electrocardiogram, stress echocardiogram, stress radionuclide, stress cardiac magnetic resonance, and computed tomographic angiography. Patient demographics, risk factors, symptoms, and NIT results were correlated with the presence of nonobstructive CAD, defined as all native coronary stenoses <50%. RESULTS: Of 661,063 patients undergoing elective angiography, 386,003 (58.4%) had nonobstructive CAD. Preprocedure NIT was performed in 64% of patients; 51.9% were reported to be abnormal, but only 9% had high-risk findings. Independent factors associated with nonobstructive CAD were younger age, female sex, atypical chest pain, and a low-risk NIT. Patients with high-risk findings on NIT were more likely to have obstructive CAD (adjusted odds ratio 3.03 [2.86-3.22]). Noninvasive test findings had minimal incremental value beyond clinical factors for predicting obstructive disease (C index = 0.75 for clinical factors vs 0.74 for NIT findings). CONCLUSION: In current practice, about two-thirds of patients undergo NIT prior to elective cardiac catheterization, yet most patients have nonobstructive CAD. The weak correlation between most NIT results and the likelihood of obstructive CAD provides further impetus for improving preangiography assessment of likelihood of disease.
BACKGROUND: Guidelines recommend noninvasive tests (NITs) to risk stratify and identify patients with higher likelihood of coronary artery disease (CAD) prior to elective coronary angiography. However, a high percentage of patients are found to have nonobstructive CAD. We aimed to understand the relationship between patient characteristics, NIT findings, and the likelihood of nonobstructive CAD. METHODS:Patients undergoing elective catheterization without history of CAD were identified from 1,128 hospitals in National Cardiovascular Data Registry's CathPCI Registry between July 2009 and December 2011. Noninvasive tests included stress electrocardiogram, stress echocardiogram, stress radionuclide, stress cardiac magnetic resonance, and computed tomographic angiography. Patient demographics, risk factors, symptoms, and NIT results were correlated with the presence of nonobstructive CAD, defined as all native coronary stenoses <50%. RESULTS: Of 661,063 patients undergoing elective angiography, 386,003 (58.4%) had nonobstructive CAD. Preprocedure NIT was performed in 64% of patients; 51.9% were reported to be abnormal, but only 9% had high-risk findings. Independent factors associated with nonobstructive CAD were younger age, female sex, atypical chest pain, and a low-risk NIT. Patients with high-risk findings on NIT were more likely to have obstructive CAD (adjusted odds ratio 3.03 [2.86-3.22]). Noninvasive test findings had minimal incremental value beyond clinical factors for predicting obstructive disease (C index = 0.75 for clinical factors vs 0.74 for NIT findings). CONCLUSION: In current practice, about two-thirds of patients undergo NIT prior to elective cardiac catheterization, yet most patients have nonobstructive CAD. The weak correlation between most NIT results and the likelihood of obstructive CAD provides further impetus for improving preangiography assessment of likelihood of disease.
Authors: Joseph L Thomas; Michael Ridner; Jason H Cole; Jeffrey W Chambers; Sabahat Bokhari; Demetris Yannopoulos; Morton Kern; Robert F Wilson; Matthew J Budoff Journal: Int J Cardiovasc Imaging Date: 2018-06-23 Impact factor: 2.357
Authors: Brendan L Eck; Raymond F Muzic; Jacob Levi; Hao Wu; Rachid Fahmi; Yuemeng Li; Anas Fares; Mani Vembar; Amar Dhanantwari; Hiram G Bezerra; David L Wilson Journal: Phys Med Biol Date: 2018-09-13 Impact factor: 3.609
Authors: Tessa S S Genders; Adrian Coles; Udo Hoffmann; Manesh R Patel; Daniel B Mark; Kerry L Lee; Ewout W Steyerberg; M G Myriam Hunink; Pamela S Douglas Journal: JACC Cardiovasc Imaging Date: 2017-06-14
Authors: Robert Roehle; Viktoria Wieske; Georg M Schuetz; Pascal Gueret; Daniele Andreini; Willem Bob Meijboom; Gianluca Pontone; Mario Garcia; Hatem Alkadhi; Lily Honoris; Jörg Hausleiter; Nuno Bettencourt; Elke Zimmermann; Sebastian Leschka; Bernhard Gerber; Carlos Rochitte; U Joseph Schoepf; Abbas Arjmand Shabestari; Bjarne Nørgaard; Akira Sato; Juhani Knuuti; Matthijs F L Meijs; Harald Brodoefel; Shona M M Jenkins; Kristian Altern Øvrehus; Axel Cosmus Pyndt Diederichsen; Ashraf Hamdan; Bjørn Arild Halvorsen; Vladimir Mendoza Rodriguez; Yung Liang Wan; Johannes Rixe; Mehraj Sheikh; Christoph Langer; Said Ghostine; Eugenio Martuscelli; Hiroyuki Niinuma; Arthur Scholte; Konstantin Nikolaou; Geir Ulimoen; Zhaoqi Zhang; Hans Mickley; Koen Nieman; Philipp A Kaufmann; Ronny Ralf Buechel; Bernhard A Herzog; Melvin Clouse; David A Halon; Jonathan Leipsic; David Bush; Reda Jakamy; Kai Sun; Lin Yang; Thorsten Johnson; Jean-Pierre Laissy; Roy Marcus; Simone Muraglia; Jean-Claude Tardif; Benjamin Chow; Narinder Paul; David Maintz; John Hoe; Albert de Roos; Robert Haase; Michael Laule; Peter Schlattmann; Marc Dewey Journal: Eur Radiol Date: 2018-03-19 Impact factor: 5.315