Low diagnostic yield of non-invasive testing in patients with suspected coronary artery disease: results from a large unselected hospital-based sample

Therming, Christina Bachmann; Galatius, Søren; Heitmann, Merete; Højberg, Søren; Sørum, Charlotte; Bech, Jan; Husum, Dorte; Domínguez, Helena; Sehestedt, Thomas; Hermann, Thomas; Reeh, Jacob; Simonsen, Lene; Prescott, Eva

doi:10.1093/ehjqcco/qcx048

Cited by 16 publications

(7 citation statements)

References 25 publications

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“…Our study shows a low rate of MACE and mortality while disappearance of angina was observed in 51, 62%. Several studies have explored the prognostic impact of stable angina in patients with CAD [5,6,7,8,21,22]. In the Multinational CLARIFY Study, among 7212 (22.1%) patients who reported angina at baseline, angina disappeared (without coronary revascularization) in 39.6% at 1 year [5].…”

Section: Discussionmentioning

confidence: 99%

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Stable Angina Pectoris: One-Year Outcomes of Patients with Obstructive Coronary Artery Disease: Multicenter Sutdy in Dakar (Senegal)

Mingou¹,

Diao²,

Ndiaye³

et al. 2022

JCCI

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Background: CAD management is important in prevention of disease progression. But we have very little study or research on the evolution of stable angina in amulatory patients without coronary antecedents and with obstructive coronary disease. Purpose: The objective of our study was to analyze the clinical and angiographic profil of patients with stable chest pain and to assess their angina status one year outcomes. Patients and methods: All patients who presented with symptomatic angina pectoris and/or signs of ischemia and first diagnosis of obstructive CAD in the Cardiology Departments of Idrissa Pouye General Hospital and Aristide Le Dantec National University Hospital Center of Dakar, from March 01, 2019 to December 31, 2020 were selected. The clinical characteristics, initial angiographic findings, therapeutic strategy and outcome within the first year were analyzed. Results: During the study period, 84 outpatients presenting with symptomatic stable chest pain and first obstructive coronary artery disease were selected. The mean age was 63.01± 9.37 years. Male preponderance was observed with 63(75%) patients; Clinical symptoms were dominated by typical pain with 46.4% (n=39) ; the risk factors were dominated by hypertension 61.9% (n=52); diabetes 41.7% (n=35) and dyslipidemia 33.3% (n=28). During follow-up, 10 patients (11.90%) remained untraceable while 9 patients (10.71%) were not available for check-up; 3 patients (3.57%) died during follow-up. Only 62 patients (73.80) could be evaluated; among those who were alive and controlled, 26 patients (41.93%) with angina at baseline still had angina symptoms, 2 patients (3.22%) had undergone myocardial infarction; one (1.61%) had undergone urgent revascularization; one (1.61%) patient developed heart failure. Finally 32 patients (51.61%) were event-free and angina-free Conclusion: The management of outpatients with stable chest pain and first obstructive CAD appears favourable, with good adherence to guideline-based therapies one year outcomes. Stable chest pain is not associated with an increased risk for adverse cardiovascular outcomes but there remains room for improvement in terms of risk factor control.

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Section: Discussionmentioning

confidence: 99%

“…As outlined in Societies of Cardiology guidelines, management strategies include lifestyle modification, risk factor reduction, pharmacological, and invasive management if significant obstructive CAD is present [1]. Several studies have explored the prognostic impact of stable angina in patients with CAD [5,6,7,8].…”

Section: Introductionmentioning

confidence: 99%

Stable Angina Pectoris: One-Year Outcomes of Patients with Obstructive Coronary Artery Disease: Multicenter Sutdy in Dakar (Senegal)

Mingou¹,

Diao²,

Ndiaye³

et al. 2022

JCCI

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“…Как уже отмечалось ранее, широкое использование неинвазивных тестов у больных с подозрением на ИБС привело к тому, что только 6-10% таких тестов на ишемию миокарда имели положительный результат [26]. Более точная оценка риска обструктивной ИБС с помощью определения клинической вероятности по одной из предложенных выше моделей, конечно, уменьшит число неинформативных неинвазивных тестов, однако проблема выбора оптимального неинвазивного теста сохраняется.…”

Section: алгоритм выбора неинвазивного/инвазивного обследованияunclassified

Assessment of Pre-test and Clinical Probability in the Diagnosis of Chronic Coronary Syndrome — What's New?

Sumin

Щеглова

2022

Racionalʹnaâ farmakoterapiâ v kardiologii

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In the 2019 European Society of Cardiology (ESC) guidelines, the diagnostic algorithm for chronic coronary syndrome (CCS) was significantly changed, a significant revision of the pretest probability assessment scale (PTP) was made, an assessment of the clinical probability of obstructive coronary artery disease was proposed, the recommendations on the use of diagnostic tests in various groups of patients were updated. Such a radical change in approaches to the diagnosis of CCS raised many questions that had to be answered by further studies conducted in the past two years. The review provides data on the validation of the new PTP scale and the proposed assessment of the clinical probability of obstructive coronary artery disease, taking into account risk factors and with the additional inclusion of information on the calcium index of coronary arteries. The proposals of experts on new algorithms for the choice of non-invasive / invasive examination of this category of patients were also considered. Overall, the new PTV rating scale (ECS 2019) has been validated and validated in retrospective analyzes of cohort studies. The scale for assessing the clinical likelihood of obstructive coronary artery disease makes it possible to classify 3.8-5 times more patients as a low probability of coronary artery disease compared to the assessment of PTP alone. Assessment of the post-test probability of coronary artery disease does not allow to confirm the presence of obstructive lesion and was not used. The experts proposed new modifications of the diagnostic algorithm (with a detailed assessment of the clinical probability, as well as without taking it into account), which require verification in further studies. Therefore, it is advisable to conduct prospective studies to confirm the possibility of reducing the total number of non-invasive and invasive studies in patients with suspected coronary heart disease, as well as the safety of such a decrease in diagnostic procedures.

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“…Широкое использование неинвазивных тестов у больных с подозрением на ИБС привело к неожиданному результату -только 6-10% НИТ на ишемию миокарда имели положительный результат [26], и в предыдущих рекомендациях при ПТВ менее 15% предлагалось не проводить дальнейшего обследования [5]. Дальнейшие исследования подчеркнули обоснованность использования отметки именно 15% как критерия непроведения дальнейших диагностических тестов.…”

Section: выбор неинвазивных и инвазивных диагностических тестовunclassified

A New Diagnostic Algorithm for Examining Patients with Suspected Chronic Coronary Syndrome: Questions Remain?

Сумин

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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In the new recommendations of the European Society of Cardiology for Chronic Coronary Syndrome, a new diagnostic algorithm is proposed in patients with suspected coronary artery disease (CAD). The purpose of this algorithm was to propose a solution of the accumulated problems in the diagnosis of CAD, in particular, a high frequency of negative non-invasive tests and unchanged coronary arteries during invasive coronary angiography. The new diagnostic algorithm includes a revision of the pre-test probability scale, the introduction of the concept of clinical probability, clarifies the role of various non-invasive tests with the central role of non-invasive testing for myocardial ischemia. However, due to the lack of data on a number of key issues, significant gaps remain that impede the use of this algorithm in practice. This review is devoted to the consideration of problematic issues of the proposed algorithm, while a critical analysis of the algorithm itself and an assessment of recent publications are carried out. Various aspects of the application of a new scale for assessing pre-test probability, determining the clinical probability of CAD, the choice of non-invasive and invasive diagnostic tests, the place of the load electrocardiography test in the diagnosis of coronary heart disease are examined in detail. Gaps in the evidence base and limitations of the algorithm are considered, as well as the possibility of its use in Russian conditions. This review can help in adapting new recommendations to domestic conditions, as well as help practitioners to use it in their daily work.

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Low diagnostic yield of non-invasive testing in patients with suspected coronary artery disease: results from a large unselected hospital-based sample

Abstract: These data confirm the very low diagnostic yield of non-invasive and invasive assessment of CAD in current clinical practice, particularly in women and in patients with atypical symptoms. Data call for a more rational approach to avoid unnecessary testing.

Cited by 16 publications

References 25 publications

Stable Angina Pectoris: One-Year Outcomes of Patients with Obstructive Coronary Artery Disease: Multicenter Sutdy in Dakar (Senegal)

Stable Angina Pectoris: One-Year Outcomes of Patients with Obstructive Coronary Artery Disease: Multicenter Sutdy in Dakar (Senegal)

Assessment of Pre-test and Clinical Probability in the Diagnosis of Chronic Coronary Syndrome — What's New?

A New Diagnostic Algorithm for Examining Patients with Suspected Chronic Coronary Syndrome: Questions Remain?

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