Low diagnostic yield of elective coronary angiography

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.