Elective Cardiac Catherization

Dr T Diagnosis, News for Professionals, Professionals 2 Comments

…slightly more than one third of patients without known disease who underwent elective cardiac catheterization had obstructive coronary artery disease…

Low Diagnostic Yield of Elective Coronary Angiography

In an article, published in the NEJM in 2010, the authors analyzed data from a national registry on cardiac catheterization, reporting only 38% of elective, diagnostic coronary angiograms showed obstructive lesions, and 39% of angiograms were interpreted as showing no disease. The findings indicate a relatively low diagnostic yield of elective coronary angiography, a procedure that exposes patients to substantial radiation.

Patients with diagnostic cardiac catheterization
from January 2004 through April 2008

     

Obstructive CAD

No Obstructive CAD

P Value

       

Total (in %)

 

Total (in %)

 

Total Caths

1,148,405

   

100.00%

     

Elective

 

629,325

 

54.80%

     

w/o known heart disease

 

397,954

 

63.24%

     

Symptomatic

   

65,735

43.90%

72231

29.10%

<0.001

Atypical

   

36,836

24.60%

109711

44.20%

<0.001

Asymptomatic

   

47,168

31.50%

66273

26.70%

<0.001

Total 

   

149,739

 

248215

   

Patients with no CAD

         

60.33%

<0.001

elective cardiac catherization

 

Patients with diagnostic cardiac catheterization
from January 2004 through April 2008

     

Obstructive CAD

No Obstructive CAD

       

Total (in %)

 

Total (in %)

Total Caths

1,148,405

   

100.00%

   

Elective

 

629,325

 

54.80%

   

w/o known heart disease

 

397,954

 

63.24%

   

Symptomatic

   

65,735

43.90%

72231

29.10%

Atypical

   

36,836

24.60%

109711

44.20%

Asymptomatic

   

47,168

31.50%

66273

26.70%

Total 

   

149,739

 

248215

 

Patients with no CAD

         

60.33%

(From: Manesh R. Patel, M.D.,et al.,N Engl J Med 362;10, 886-895)

Comments 2

  1. Hello,

    Dr T what would you recommend today as an initial screening tool to assess the level of cardiovascular disease in a patient today. 50yrs age, male, 2 two risk factors.

    I am considering CTA with “virtual” FFR. Thoughts?

    Thanks for you general opinion.

  2. Post
    Author

    The results indicate that elective cardiac catherization is a poor tool as an initial screening test. Since other, less invasive and expensive tests are available, one wonders what prompted unnecessary cathetrization in over 60% of the patients studied in this paper.

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