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Prediction of coronary artery disease severity in patients referred for coronary angiography
David Rott1, Jesaia Benhorin, Andre Keren
1Department of Medicine Mt. Scopus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. drott@012.net.il
Insights
A new formula predicts triple-vessel disease (3VD) or left main disease (LMD) in patients undergoing coronary angiography. This helps avoid pre-procedure clopidogrel loading in high-risk individuals, reducing surgical complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Coronary angiography is often followed by stenting, with aspirin and clopidogrel as standard treatment.
- Pretreatment with clopidogrel can complicate subsequent coronary artery bypass graft (CABG) surgery due to bleeding risks.
- Identifying patients likely to need CABG surgery before angiography is crucial for treatment planning.
Purpose of the Study:
- To develop and validate a risk factor-based formula to predict the likelihood of triple-vessel disease (3VD) or left main disease (LMD).
- To aid in deciding whether to administer clopidogrel loading before coronary angiography.
Main Methods:
- A logistic regression model was developed using a training subset of 1,296 patients referred for coronary angiography.
- Five variables (age, gender, diabetes, hypercholesterolemia, prior myocardial infarction) were identified as strong predictors of 3VD or LMD.
- The model was validated on an independent subset of 884 patients.
Main Results:
- The predictive formula demonstrated 79% sensitivity and 83% negative predictive value for 3VD or LMD in the validation set.
- Specificity was 53%, and positive predictive value was 45%.
Conclusions:
- A simple formula incorporating five clinical variables effectively predicts the likelihood of 3VD or LMD in patients undergoing coronary angiography.
- This tool can help clinicians avoid pre-procedure clopidogrel loading in patients at high risk for CABG surgery, thereby mitigating surgical risks.
Background:
Diagnostic coronary angiography is often followed by coronary stenting. Therapy with aspirin and clopidogrel is currently the standard treatment for patients undergoing coronary stenting. Clopidogrel loading is usually given prior to the procedure. Some pretreated patients, however, are found to have triple-vessel disease (3VD) or left main disease (LMD) that requires referral for coronary artery bypass graft (CABG) surgery. Surgery in patients pretreated with clopidogrel may be complicated by excessive bleeding or delayed to avoid that risk.
Hypothesis:
A risk factor-based formula may predict the likelihood that patients referred for coronary angiography will have 3VD or LMD.
Methods:
Consecutive patients (n = 2,180) referred for coronary angiography constitute the training subset (n = 1,296) used to build the model, and the validation subset (n = 884) used to test the model. Logistic regression models selected five variables showing strong associations with the presence of 3VD or LMD: age, gender, diabetes, hypercholesterolemia, and prior myocardial infarction (MI). A formula based on these variables and on the training subset was constructed to calculate the probability of 3VD or LMD.
Results:
Applying this model to the validation subset predicted 3VD or LMD with 79% sensitivity, 53% specificity, 45% positive predictive value, and 83% negative predictive value.
Conclusions:
This simple formula based on five clinical variables is helpful in predicting the likelihood that patients, referred for coronary angiography, will have 3VD or LMD. Use of this formula can help decide in which patients clopidogrel loading prior to angiography should be avoided.
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