(From: Low Diagnostic Yield of Elective Coronary Angiography, Manesh R. Patel, M.D.,et al.,N Engl J Med 362;10, 886-895)
…slightly more than one third of patients without known disease who underwent elective cardiac catheterizationhad obstructive coronary artery disease.
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 January 2004 – April 2008 |
||||||
| Obstructive CAD | No Obstructive CAD | |||||
| Total | Total | |||||
| 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 | 100.00% | 248215 | 100.00% | ||
| Obstructive CAD | No Obstructive CAD | Total | P Value | |
| (N = 149,739) | (N = 248,215) | (N = 397,954) | ||
| Clinical presentation (%) | ||||
| No symptoms, including no angina | 31.5 | 29.1 | 30 | <0.001 |
| Atypical symptoms | 24.6 | 44.2 | 36.8 | <0.001 |
| Stable angina | 43.9 | 26.7 | 33.2 | <0.001 |
| 100 | 100 | 100 | ||
| No. of patients | 149,739 | 248,215 | 60.33% | <0.001 |
| Obstructive CAD | No Obstructive CAD | Total | P Value | |
| (N = 149,739) | (N = 248,215) | (N = 397,954) | ||
| Clinical presentation (%) | ||||
| No symptoms, including no angina | 31.5 | 29.1 | 30 | <0.001 |
| Atypical symptoms | 24.6 | 44.2 | 36.8 | <0.001 |
| Stable angina | 43.9 | 26.7 | 33.2 | <0.001 |
| 100 | 100 | 100 | ||
| No. of patients | 149,739 | 248,215 | 60.33% | <0.001 |