Visual estimates of percent diameter coronary stenosis: “A battered gold standard”

Marcus, Melvin L.; Skorton, David J.; Johnson, Maryl R.; Collins, Steve; Harrison, David G.; Kerber, Richard E.

doi:10.1016/0735-1097(88)90226-4

Cited by 244 publications

(51 citation statements)

References 37 publications

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“…Despite its limitations, coronary angiography remains the gold standard for the diagnosis of coronary disease [10][11][12][13]. One may therefore assume that coronary angiog raphy has a sensitivity and specificity of 100%.…”

Section: Conditional Probability Analysis and Clinical Decision-makingmentioning

confidence: 99%

Diagnostic Evaluation of Women with Suspected Coronary Artery Disease

Heller¹

1995

Cardiology

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Women are less likely than men to be referred for coronary angiography. It is unclear whether this reflects good clinical judgment or agenda bias. The decision to refer a patient for an invasive evaluation depends upon the prevalence of disease and the population in question, the prognosis of patients with coronary artery disease and the response of these patients of the available therapies. This paper reviews the statistical basis for clinical decision making and the available epidemiologic and risk factor data in women with suspected coronary artery disease. The results of noninvasive testing in women are also reviewed. Finally, guidelines are suggested to help determine when a woman with suspected coronary artery disease should be referred for coronary angiography.

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Section: Conditional Probability Analysis and Clinical Decision-makingmentioning

confidence: 99%

Diagnostic Evaluation of Women with Suspected Coronary Artery Disease

Heller¹

1995

Cardiology

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“…Although the visual method still represents the most widely used technique for assessing coronary stenosis severity [8,9,20,22,23,27], it introduces an additional level of subjectivity in data analysis, and represents a source of bias, as the use of a rough percent diameter narrowing ignores the full geometric impact of a stenosis on coronary blood flow [33]. Therefore, the true significance of these results needs be confirmed by studies using computer-assisted quantitation of luminal narrowings.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Single-day combined evaluation of regional myocardial perfusion and function at rest and peak exercise with99mTc-MIBI in patients with coronary artery disease

et al. 1993

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Abstract99mTc-labeled methoxy-isobutyl-isonitrile (MIBI) allows a simultaneous radionuclide assessment of regional heart function and perfusion. In this study the effectiveness of functional and perfusional images obtained with ~gmTc-MIBI in the detection of coronary stenoses was compared with that of their combination.We studied 197 patients who underwent coronary angiography and a single-day radionuclide protocol including first pass angiography (multicrystal gamma camera) and single photon emission computed tomography, by means of 2 injections of 99mTc-MIBI at rest and at peak exercise. Fifteen patients had < 50% stenoses, 50 had 1-vessel, 69 2-vessel and 63 3-vessel disease, for a total of 377 pathological major coronary vessels; 129 patients had previous myocardial infarction. Functional images, perfusional tomograms and their combination showed the same sensitivity (98%) and specificity (80%) in detecting coronary patients. Regional sensitivity and specificity of the combined analysis achieved 87% and 82%, respectively, vs. 94% (p < 0.005) and 60% (p < 0.001) of functional images, and 88% (p = N.S.) and 74% (p < 0.05) of perfusional tomograms.Thus, the combined analysis of regional functional and perfusional abnormalities increased significantly the specificity in the detection of coronary stenoses, in comparison with the separate evaluation of function and perfusion, achieving also a slightly higher diagnostic accuracy (85%, vs. 81% and 83%, respectively). The results confirm that a single-day protocol simultaneously assessing regional myocardial function and perfusion with 99mTc-MIBI represents a rapid and effective diagnostic method, that allows the physician to assess the presence and functional importance of coronary stenoses in less than 4 hours.

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“…35 Variability among observers exists in assigning the degree of stenosis. 36 and no consensus is present regarding the threshold for what constitutes a "significant" lesion. Furthermore, poor correlation exists with postmortem findings, and, most importantly, discordance with physiological assessment.…”

Section: Coronary Anatomy and Physiologymentioning

confidence: 99%

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

Hendel¹

2009

Circ: Cardiovascular Imaging

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Visual estimates of percent diameter coronary stenosis: “A battered gold standard”

Cited by 244 publications

References 37 publications

Diagnostic Evaluation of Women with Suspected Coronary Artery Disease

Diagnostic Evaluation of Women with Suspected Coronary Artery Disease

Single-day combined evaluation of regional myocardial perfusion and function at rest and peak exercise with99mTc-MIBI in patients with coronary artery disease

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

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