Low Diagnostic Yield of Elective Coronary Angiography

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(From: Low Diagnostic Yield of Elective Coronary AngiographyManesh 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
 

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