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Is elective coronary angiography overused in patients with suspected coronary artery disease?
MedLine Citation:
PMID:  20608817     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Marc-Alexander Ohlow
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Publication Detail:
Type:  Comment; Journal Article    
Journal Detail:
Title:  Future cardiology     Volume:  6     ISSN:  1744-8298     ISO Abbreviation:  Future Cardiol     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-08     Completed Date:  2010-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101239345     Medline TA:  Future Cardiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  455-7     Citation Subset:  -    
Affiliation:
Division of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany. m.ohlow.kar@zentralklinik-bad-berka.de
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Comment On:
N Engl J Med. 2010 Mar 11;362(10):886-95   [PMID:  20220183 ]

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