Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography
Objective : 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 p...
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ftunivtroemsoe:oai:munin.uit.no:10037/14665 2023-05-15T17:39:23+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 2018-11-01 https://hdl.handle.net/10037/14665 https://doi.org/10.1136/openhrt-2018-000888 eng eng BMJ Publishing Group Fladseth, K. (2022). Clinical characteristics, mortality and pain tolerance in stable versus acute presentation of coronary heart disease. (Doctoral thesis). https://hdl.handle.net/10037/26711 . Open heart Fladseth, K., Kristensen, A., Mannsverk, J., Trovik, T. & Schirmer, H. (2018). Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography. Open heart, 5 (2). https://doi.org/10.1136/openhrt-2018-000888 FRIDAID 1637524 doi:10.1136/openhrt-2018-000888 2053-3624 https://hdl.handle.net/10037/14665 openAccess VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 Journal article Tidsskriftartikkel Peer reviewed 2018 ftunivtroemsoe https://doi.org/10.1136/openhrt-2018-000888 2022-09-14T23:00:12Z Objective : 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. Methods : 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. Results 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. Conclusions : 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 University of Tromsø: Munin Open Research Archive Norway Open Heart 5 2 e000888 |
institution |
Open Polar |
collection |
University of Tromsø: Munin Open Research Archive |
op_collection_id |
ftunivtroemsoe |
language |
English |
topic |
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 |
spellingShingle |
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 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 |
topic_facet |
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 |
description |
Objective : 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. Methods : 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. Results 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. Conclusions : 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 |
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 |
https://hdl.handle.net/10037/14665 https://doi.org/10.1136/openhrt-2018-000888 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
North Norway |
genre_facet |
North Norway |
op_relation |
Fladseth, K. (2022). Clinical characteristics, mortality and pain tolerance in stable versus acute presentation of coronary heart disease. (Doctoral thesis). https://hdl.handle.net/10037/26711 . Open heart Fladseth, K., Kristensen, A., Mannsverk, J., Trovik, T. & Schirmer, H. (2018). Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography. Open heart, 5 (2). https://doi.org/10.1136/openhrt-2018-000888 FRIDAID 1637524 doi:10.1136/openhrt-2018-000888 2053-3624 https://hdl.handle.net/10037/14665 |
op_rights |
openAccess |
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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1766140154818330624 |