Related Experiment Video
Updated: Jan 11, 2026
Bone Marrow Sampling and Transplants
Low diagnostic yield of elective coronary angiography
Manesh R Patel1, Eric D Peterson, David Dai
1Duke Clinical Research Institute, Duke University, Durham, NC 27715, USA. manesh.patel@duke.edu
Insights
Cardiac catheterization revealed obstructive coronary artery disease in over one-third of patients without known disease. Improved risk stratification is crucial for optimizing diagnostic yield in clinical practice.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Current guidelines advocate risk assessment and noninvasive testing for cardiac catheterization triaging.
- This study examines noninvasive testing patterns and catheterization yield in patients with suspected coronary artery disease.
Purpose of the Study:
- To determine patterns of noninvasive testing in patients undergoing elective cardiac catheterization.
- To evaluate the diagnostic yield of cardiac catheterization in a contemporary national sample.
Main Methods:
- Analysis of data from 663 hospitals in the American College of Cardiology National Cardiovascular Data Registry (2004-2008).
- Inclusion of patients without known coronary artery disease undergoing elective catheterization.
- Correlation of patient demographics, risk factors, symptoms, and noninvasive test results with obstructive coronary artery disease (defined as ≥50% left main or ≥70% major epicardial vessel stenosis).
Main Results:
- 398,978 patients were analyzed; 37.6% had obstructive coronary artery disease.
- Noninvasive testing was performed in 83.9% of patients.
- Independent predictors of obstructive coronary artery disease included male sex, older age, insulin-dependent diabetes, and dyslipidemia. Positive noninvasive tests moderately increased the likelihood of obstructive coronary artery disease (41.0% vs. 35.0%).
Conclusions:
- Approximately one-third of patients without prior known coronary artery disease undergoing elective catheterization had obstructive disease.
- Enhanced risk stratification strategies are necessary to improve decision-making and increase the diagnostic utility of cardiac catheterization.
Background:
Guidelines for triaging patients for cardiac catheterization recommend a risk assessment and noninvasive testing. We determined patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected coronary artery disease in a contemporary national sample.
Methods:
From January 2004 through April 2008, at 663 hospitals in the American College of Cardiology National Cardiovascular Data Registry, we identified patients without known coronary artery disease who were undergoing elective catheterization. The patients' demographic characteristics, risk factors, and symptoms and the results of noninvasive testing were correlated with the presence of obstructive coronary artery disease, which was defined as stenosis of 50% or more of the diameter of the left main coronary artery or stenosis of 70% or more of the diameter of a major epicardial vessel.
Results:
A total of 398,978 patients were included in the study. The median age was 61 years; 52.7% of the patients were men, 26.0% had diabetes, and 69.6% had hypertension. Noninvasive testing was performed in 83.9% of the patients. At catheterization, 149,739 patients (37.6%) had obstructive coronary artery disease. No coronary artery disease (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, 2.70; 95% confidence interval [CI], 2.64 to 2.76), older age (odds ratio per 5-year increment, 1.29; 95% CI, 1.28 to 1.30), presence of insulin-dependent diabetes (odds ratio, 2.14; 95% CI, 2.07 to 2.21), and presence of dyslipidemia (odds ratio, 1.62; 95% CI, 1.57 to 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 (41.0% vs. 35.0%; P<0.001; adjusted odds ratio, 1.28; 95% CI, 1.19 to 1.37).
Conclusions:
In this study, slightly more than one third of patients without known disease who underwent elective cardiac catheterization had obstructive coronary artery disease. Better strategies for risk stratification are needed to inform decisions and to increase the diagnostic yield of cardiac catheterization in routine clinical practice.
