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Diagnosis of chronic obstructive coronary artery disease: is non-invasive testing the suitable gatekeeper for coronary angiography?
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Fernando Guilherme Ribeiro Mané
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Fernando Ribeiro Mané; Carla Rodrigues; Cátia Oliveira; Rui Flores; Paulo Medeiros; Rodrigo Silva; Isabel Campos; João Costa; Carlos Braga; Catarina Quina; Jorge Marques
Abstract
<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black"><strong>INTRODUCTION: </strong>The prevalence of patients without obstructive coronary artery disease (CAD) among those undergoing invasive coronary angiography (ICA) is significant. Identifying patients that will benefit from an invasive approach is essential to avoid unnecessary risks and costs. Current guidelines advocate the use of non-invasive tests to establish CAD diagnosis according to its clinical likelihood, with the majority of patients being eligible to undergo a functional non-invasive imaging test for myocardial ischemia before ICA is considered.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black"><strong>AIMS: </strong>The authors aim to describe the patterns of non-invasive testing among patients undergoing ICA and to determine their incremental value in current practice.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black"><strong>METHODS: </strong>Characteristics and results of 358 consecutive patients without known CAD undergoing ICA in a signle-centre were collected. We evaluated the prevalence of obstructive coronary disease (defined as the presence of at least one ≥50% stenosis on ICA) according to the use of non-invasive testing and compared the results with the patients referred to ICA without a positive non-invasive test.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black"><strong>RESULTS: </strong>Non-invasive testing was performed in 79% of the patients.<strong> </strong>The baseline characteristics of the patients that underwent non-invasive testing were not significantly different from those referred to ICA without previous testing.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black">Rates of obstructive CAD and myocardial revascularization according to the positive non-invasive test that drived referral to ICA are illustrated (Figure 1).</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black">The prevalence of obstructive coronary disease was significantly higher in patients that underwent non-invasive testing than in those who did not (56% vs 40%, p=0.01). A positive non-invasive test was marginally associated with increased risk of obstructive CAD (adjusted odds ratio 1.73 CI95% [0.95-2.98], p = 0.07) and had modest Incremental value in the prediction of obstructive CAD when included in a multivariate regression model based in clinical characteristics (C-statistic of 0.733 vs. 0.727).</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black">Furthermore, non-invasive testing was associated with higher rates of revascularization when compared with non-tested patients (37% vs 21%, p=0.01).</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:"Arial Narrow""><span style="color:black"><strong>CONCLUSION: </strong>Non-invasive tests are able to improve the coronary angiography diagnostic yield by fairly performing as gatekeepers. However, the current diagnosis pathway leading to ICA underperforms despite the widespread testing. Hence, complementary risk-stratification strategies are needed to avoid futile procedures.</span></span></span></p>
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