Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography
Patients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of...
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ftoslouniv:oai:www.duo.uio.no:10852/72337 2023-05-15T17:39:24+02:00 Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography Fladseth, Kristina Kristensen, Andreas Mannsverk, Jan Trovik, Thor Schirmer, Henrik 2018-11-30T12:29:43Z http://hdl.handle.net/10852/72337 http://urn.nb.no/URN:NBN:no-75433 https://doi.org/10.1136/openhrt-2018-000888 EN eng BMJ Publishing Group http://urn.nb.no/URN:NBN:no-75433 Fladseth, Kristina Kristensen, Andreas Mannsverk, Jan Trovik, Thor Schirmer, Henrik . Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography. Open heart. 2018, 5(2) http://hdl.handle.net/10852/72337 1637524 info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Open heart&rft.volume=5&rft.spage=&rft.date=2018 Open heart 5 2 https://doi.org/10.1136/openhrt-2018-000888 URN:NBN:no-75433 Fulltext https://www.duo.uio.no/bitstream/handle/10852/72337/1/e000888.full.pdf Attribution-NonCommercial 4.0 International https://creativecommons.org/licenses/by-nc/4.0/ CC-BY-NC 2053-3624 Journal article Tidsskriftartikkel Peer reviewed PublishedVersion 2018 ftoslouniv https://doi.org/10.1136/openhrt-2018-000888 2020-06-21T08:53:08Z Patients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of obstructive CAD in patients with UA referred for acute CAG.From 2005 to 2012, all CAGs performed at the University Hospital of North Norway, the sole provider of CAG in the region, were recorded in a registry. We included 979 admissions of UA and retrospectively collected data regarding presenting clinical parameters from patient hospital records. Obstructive CAD was defined as ≥50% stenosis and considered prognostically significant if found in the left main stem, proximal LAD or all three main coronary arteries. Characteristics were analysed by logistic regression analysis. A score was developed using ORs from significant factors in a multivariable model.The overall rate of obstructive CAD was 45%, and the rate of prognostically significant CAD was 11%. The risk criteria recommended in American College of Cardiology/American Heart Association and European Society of Cardiology guidelines had an area under the curve (AUC) of 0.58. Adding clinical information increased the AUC to 0.77 (95% CI 0.74 to 0.80). Applying the derived score, we found that 56% (n=546) of patients had a score of <13, which was associated with a negative predictive value of 95% for prognostic significant CAD.The current results suggest that CAG may be postponed or cancelled in more than half of patients with UA by improving pre-test selection criteria with the addition of clinical parameters to current guidelines. Article in Journal/Newspaper North Norway Universitet i Oslo: Digitale utgivelser ved UiO (DUO) Norway Open Heart 5 2 e000888 |
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Open Polar |
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Universitet i Oslo: Digitale utgivelser ved UiO (DUO) |
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ftoslouniv |
language |
English |
description |
Patients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of obstructive CAD in patients with UA referred for acute CAG.From 2005 to 2012, all CAGs performed at the University Hospital of North Norway, the sole provider of CAG in the region, were recorded in a registry. We included 979 admissions of UA and retrospectively collected data regarding presenting clinical parameters from patient hospital records. Obstructive CAD was defined as ≥50% stenosis and considered prognostically significant if found in the left main stem, proximal LAD or all three main coronary arteries. Characteristics were analysed by logistic regression analysis. A score was developed using ORs from significant factors in a multivariable model.The overall rate of obstructive CAD was 45%, and the rate of prognostically significant CAD was 11%. The risk criteria recommended in American College of Cardiology/American Heart Association and European Society of Cardiology guidelines had an area under the curve (AUC) of 0.58. Adding clinical information increased the AUC to 0.77 (95% CI 0.74 to 0.80). Applying the derived score, we found that 56% (n=546) of patients had a score of <13, which was associated with a negative predictive value of 95% for prognostic significant CAD.The current results suggest that CAG may be postponed or cancelled in more than half of patients with UA by improving pre-test selection criteria with the addition of clinical parameters to current guidelines. |
format |
Article in Journal/Newspaper |
author |
Fladseth, Kristina Kristensen, Andreas Mannsverk, Jan Trovik, Thor Schirmer, Henrik |
spellingShingle |
Fladseth, Kristina Kristensen, Andreas Mannsverk, Jan Trovik, Thor Schirmer, Henrik Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography |
author_facet |
Fladseth, Kristina Kristensen, Andreas Mannsverk, Jan Trovik, Thor Schirmer, Henrik |
author_sort |
Fladseth, Kristina |
title |
Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography |
title_short |
Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography |
title_full |
Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography |
title_fullStr |
Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography |
title_full_unstemmed |
Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography |
title_sort |
pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography |
publisher |
BMJ Publishing Group |
publishDate |
2018 |
url |
http://hdl.handle.net/10852/72337 http://urn.nb.no/URN:NBN:no-75433 https://doi.org/10.1136/openhrt-2018-000888 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
North Norway |
genre_facet |
North Norway |
op_source |
2053-3624 |
op_relation |
http://urn.nb.no/URN:NBN:no-75433 Fladseth, Kristina Kristensen, Andreas Mannsverk, Jan Trovik, Thor Schirmer, Henrik . Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography. Open heart. 2018, 5(2) http://hdl.handle.net/10852/72337 1637524 info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Open heart&rft.volume=5&rft.spage=&rft.date=2018 Open heart 5 2 https://doi.org/10.1136/openhrt-2018-000888 URN:NBN:no-75433 Fulltext https://www.duo.uio.no/bitstream/handle/10852/72337/1/e000888.full.pdf |
op_rights |
Attribution-NonCommercial 4.0 International https://creativecommons.org/licenses/by-nc/4.0/ |
op_rightsnorm |
CC-BY-NC |
op_doi |
https://doi.org/10.1136/openhrt-2018-000888 |
container_title |
Open Heart |
container_volume |
5 |
container_issue |
2 |
container_start_page |
e000888 |
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1766140156579938304 |