Low diagnostic yield of elective coronary angiography

January 01, 0001

Low diagnostic yield of elective coronary angiography

Guidelines for triaging patients for cardiac catheterization recommend a risk assessment and noninvasive testing. These US authors determined patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected coronary artery disease in a contemporary national sample. They identified patients without known coronary artery disease who were undergoing elective catheterization. The patients' demographic characteristics, risk factors, and symptoms and the results of noninvasive testing were correlated with the presence of obstructive coronary artery disease, which was defined as stenosis of 50% or more of the diameter of the left main coronary artery or stenosis of 70% or more of the diameter of a major epicardial vessel.

They found: "A total of 398,978 patients were included in the study. The median age was 61 years; 52.7% of the patients were men, 26.0% had diabetes, and 69.6% had hypertension. Noninvasive testing was performed in 83.9% of the patients. At catheterization, 149,739 patients (37.6%) had obstructive coronary artery disease. No coronary artery disease (defined as less than 20% stenosis in all vessels) was reported in 39.2% of the patients. Independent predictors of obstructive coronary artery disease included male sex (odds ratio, 2.70), older age (odds ratio per 5-year increment, 1.29), presence of insulin-dependent diabetes (odds ratio, 2.14), and presence of dyslipidemia (odds ratio, 1.62). Patients with a positive result on a noninvasive test were moderately more likely to have obstructive coronary artery disease than those who did not undergo any testing (41.0% vs. 35.0, adjusted odds ratio 1.28)."

The authors concluded: "In this study, slightly more than one third of patients without known disease who underwent elective cardiac catheterization had obstructive coronary artery disease. Better strategies for risk stratification are needed to inform decisions and to increase the diagnostic yield of cardiac catheterization in routine clinical practice."

More important would be to what extent catheterization improved outcomes for these patients vs. medical management without catheterization.

For the full abstract, click here.

N Engl J Med 362(10):886-895, 11 March 2010
© 2010 to the Massachusett Medical Society
Low Diagnostic Yield of Elective Coronary Angiography. Manesh R. Patel, Eric D. Peterson, David Dai, et al. Correspondence to Dr. Patel: manesh.patel@duke.edu

Category: K. Circulatory. Keywords: cardiac catheterization, coronary artery disease, diagnostic testing, observational study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 23 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.