alexa Is elective coronary angiography overused in patients with suspected coronary artery disease?


Journal of Vascular Medicine & Surgery

Author(s): Ohlow MA

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Abstract Evaluation of: Patel M, Peterson E, Dai D et al.: Low diagnostic yield of elective coronary angiography. N. Engl. J. Med. 362, 886-895 (2010). Guidelines for triaging patients for cardiac catheterization recommend risk assessment and noninvasive testing. The article by Patel et al. analyzes 398,978 patients and shows that only 37.6\% had obstructive coronary artery disease at catheterization. No coronary artery stenosis (defined as <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 [OR]: 2.70; 95\% CI: 2.64-2.76), older age (OR: 1.29; 95\% CI: 1.28-1.30), presence of diabetes (OR: 2.14; 95\% CI: 2.07-2.21) and dyslipidemia (OR: 1.62; 95\% CI: 1.57-1.67). 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 vs 35\%; p < 0.001; adjusted OR: 1.28; 95\% CI: 1.19-1.37). However, an angiogram's results do not tell us whether it was appropriately ordered. As the noninvasive testing variable included a wide range of procedures, we cannot speculate from the data how many diagnostic angiographies could have been avoided. This article was published in Future Cardiol and referenced in Journal of Vascular Medicine & Surgery

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