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Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

BACKGROUND: Guidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography. OBJECTIVE: We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD. METHODS: We prospe...

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Detalles Bibliográficos
Autores principales: Costa Filho, Francisco Flávio, Chaves, Áurea Jacob, Ligabó, Lourenço Teixeira, dos Santos, Eduardo Moreira, da Silva, Danillo Taiguara, Puzzi, Marcelo Aguiar, Braga, Sérgio Luiz, Abizaid, Alexandre, Sousa, Amanda GMR
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Cardiologia 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651404/
https://www.ncbi.nlm.nih.gov/pubmed/26312552
http://dx.doi.org/10.5935/abc.20150099
Descripción
Sumario:BACKGROUND: Guidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography. OBJECTIVE: We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD. METHODS: We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests. RESULTS: A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77), age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26), diabetes (OR, 2.01; CI 95%, 1.40 - 2.90), dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07), typical angina (OR, 2.92; CI 95%, 1.77 - 4.83) and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27). CONCLUSIONS: In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.