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recordid: cdi_proquest_miscellaneous_748956687
title: A Proposed Clinical Model for Efficient Utilization of Invasive Coronary Angiography
format: Article
creator:
  • Taylor, Carolyn M., MD, MPH
  • Humphries, Karin H., DSc
  • Pu, Aihua, MSc
  • Ghali, William, MD, MPH
  • Gao, Min, MD, PhD
  • Knudtson, Merril, MD
  • Hoffmann, Udo, MD, MPH
  • Carere, Ronald G., MD
subjects:
  • Abridged Index Medicus
  • Aged
  • Biological and medical sciences
  • Cardiology
  • Cardiology. Vascular system
  • Cardiovascular
  • Cardiovascular disease
  • Cardiovascular system
  • Clinical medicine
  • Coronary Angiography
  • Coronary Stenosis - diagnostic imaging
  • Female
  • Humans
  • Intubation
  • Investigative techniques, diagnostic techniques (general aspects)
  • Male
  • Medical diagnosis
  • Medical imaging
  • Medical sciences
  • Middle Aged
  • Models, Biological
  • Myocardial Ischemia - diagnosis
  • Predictive Value of Tests
  • Radiodiagnosis. Nmr imagery. Nmr spectrometry
  • Registries
ispartof: The American journal of cardiology, 2010, Vol.106 (4), p.457-462
description: More than 1/4 of patients who undergo invasive coronary angiography are found to have no visible or nonobstructive (
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titleA Proposed Clinical Model for Efficient Utilization of Invasive Coronary Angiography
creatorTaylor, Carolyn M., MD, MPH ; Humphries, Karin H., DSc ; Pu, Aihua, MSc ; Ghali, William, MD, MPH ; Gao, Min, MD, PhD ; Knudtson, Merril, MD ; Hoffmann, Udo, MD, MPH ; Carere, Ronald G., MD
creatorcontribTaylor, Carolyn M., MD, MPH ; Humphries, Karin H., DSc ; Pu, Aihua, MSc ; Ghali, William, MD, MPH ; Gao, Min, MD, PhD ; Knudtson, Merril, MD ; Hoffmann, Udo, MD, MPH ; Carere, Ronald G., MD
descriptionMore than 1/4 of patients who undergo invasive coronary angiography are found to have no visible or nonobstructive (<50% stenosis) coronary artery disease (CAD). With the rapid evolution of noninvasive imaging for CAD diagnosis, avoiding invasive coronary angiography in patients unlikely to require coronary revascularization is desirable. We undertook to develop a clinical prediction tool to identify patients with a low likelihood of obstructive (≥50% stenosis) CAD. The derivation cohort included 24,637 patients with a diagnosis of “stable angina” or “acute coronary syndrome” referred for first cardiac catheterization in the province of British Columbia, Canada. The model was validated using an external dataset from the province of Alberta and comprised 18,606 patients. Seven variables (female gender, age <50 years, atypical Canadian Cardiovascular Society angina class, absence of ST-segment change on electrocardiogram, lifelong nonsmoking, and absence of diabetes and hyperlipidemia) were associated with the angiographic finding of “no or nonobstructive CAD.” The c-statistics for the derivation model were 0.76 and 0.74 using the validation dataset. In conclusion, this simple clinical prediction tool, applied to patients for whom determination of coronary anatomy was clinically indicated, identifies patients who have a low likelihood of obstructive CAD. The patient population identified by this tool may represent a population best suited to a noninvasive diagnostic strategy.
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languageeng
publisherNew York, NY: Elsevier Inc
subjectAbridged Index Medicus ; Aged ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Cardiovascular system ; Clinical medicine ; Coronary Angiography ; Coronary Stenosis - diagnostic imaging ; Female ; Humans ; Intubation ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical diagnosis ; Medical imaging ; Medical sciences ; Middle Aged ; Models, Biological ; Myocardial Ischemia - diagnosis ; Predictive Value of Tests ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Registries
ispartofThe American journal of cardiology, 2010, Vol.106 (4), p.457-462
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0Taylor, Carolyn M., MD, MPH
1Humphries, Karin H., DSc
2Pu, Aihua, MSc
3Ghali, William, MD, MPH
4Gao, Min, MD, PhD
5Knudtson, Merril, MD
6Hoffmann, Udo, MD, MPH
7Carere, Ronald G., MD
title
0A Proposed Clinical Model for Efficient Utilization of Invasive Coronary Angiography
1The American journal of cardiology
addtitleAm J Cardiol
descriptionMore than 1/4 of patients who undergo invasive coronary angiography are found to have no visible or nonobstructive (<50% stenosis) coronary artery disease (CAD). With the rapid evolution of noninvasive imaging for CAD diagnosis, avoiding invasive coronary angiography in patients unlikely to require coronary revascularization is desirable. We undertook to develop a clinical prediction tool to identify patients with a low likelihood of obstructive (≥50% stenosis) CAD. The derivation cohort included 24,637 patients with a diagnosis of “stable angina” or “acute coronary syndrome” referred for first cardiac catheterization in the province of British Columbia, Canada. The model was validated using an external dataset from the province of Alberta and comprised 18,606 patients. Seven variables (female gender, age <50 years, atypical Canadian Cardiovascular Society angina class, absence of ST-segment change on electrocardiogram, lifelong nonsmoking, and absence of diabetes and hyperlipidemia) were associated with the angiographic finding of “no or nonobstructive CAD.” The c-statistics for the derivation model were 0.76 and 0.74 using the validation dataset. In conclusion, this simple clinical prediction tool, applied to patients for whom determination of coronary anatomy was clinically indicated, identifies patients who have a low likelihood of obstructive CAD. The patient population identified by this tool may represent a population best suited to a noninvasive diagnostic strategy.
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0Abridged Index Medicus
1Aged
2Biological and medical sciences
3Cardiology
4Cardiology. Vascular system
5Cardiovascular
6Cardiovascular disease
7Cardiovascular system
8Clinical medicine
9Coronary Angiography
10Coronary Stenosis - diagnostic imaging
11Female
12Humans
13Intubation
14Investigative techniques, diagnostic techniques (general aspects)
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16Medical diagnosis
17Medical imaging
18Medical sciences
19Middle Aged
20Models, Biological
21Myocardial Ischemia - diagnosis
22Predictive Value of Tests
23Radiodiagnosis. Nmr imagery. Nmr spectrometry
24Registries
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1Humphries, Karin H., DSc
2Pu, Aihua, MSc
3Ghali, William, MD, MPH
4Gao, Min, MD, PhD
5Knudtson, Merril, MD
6Hoffmann, Udo, MD, MPH
7Carere, Ronald G., MD
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titleA Proposed Clinical Model for Efficient Utilization of Invasive Coronary Angiography
authorTaylor, Carolyn M., MD, MPH ; Humphries, Karin H., DSc ; Pu, Aihua, MSc ; Ghali, William, MD, MPH ; Gao, Min, MD, PhD ; Knudtson, Merril, MD ; Hoffmann, Udo, MD, MPH ; Carere, Ronald G., MD
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1Aged
2Biological and medical sciences
3Cardiology
4Cardiology. Vascular system
5Cardiovascular
6Cardiovascular disease
7Cardiovascular system
8Clinical medicine
9Coronary Angiography
10Coronary Stenosis - diagnostic imaging
11Female
12Humans
13Intubation
14Investigative techniques, diagnostic techniques (general aspects)
15Male
16Medical diagnosis
17Medical imaging
18Medical sciences
19Middle Aged
20Models, Biological
21Myocardial Ischemia - diagnosis
22Predictive Value of Tests
23Radiodiagnosis. Nmr imagery. Nmr spectrometry
24Registries
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0Taylor, Carolyn M., MD, MPH
1Humphries, Karin H., DSc
2Pu, Aihua, MSc
3Ghali, William, MD, MPH
4Gao, Min, MD, PhD
5Knudtson, Merril, MD
6Hoffmann, Udo, MD, MPH
7Carere, Ronald G., MD
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0Taylor, Carolyn M., MD, MPH
1Humphries, Karin H., DSc
2Pu, Aihua, MSc
3Ghali, William, MD, MPH
4Gao, Min, MD, PhD
5Knudtson, Merril, MD
6Hoffmann, Udo, MD, MPH
7Carere, Ronald G., MD
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volume106
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pages457-462
issn0002-9149
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abstractMore than 1/4 of patients who undergo invasive coronary angiography are found to have no visible or nonobstructive (<50% stenosis) coronary artery disease (CAD). With the rapid evolution of noninvasive imaging for CAD diagnosis, avoiding invasive coronary angiography in patients unlikely to require coronary revascularization is desirable. We undertook to develop a clinical prediction tool to identify patients with a low likelihood of obstructive (≥50% stenosis) CAD. The derivation cohort included 24,637 patients with a diagnosis of “stable angina” or “acute coronary syndrome” referred for first cardiac catheterization in the province of British Columbia, Canada. The model was validated using an external dataset from the province of Alberta and comprised 18,606 patients. Seven variables (female gender, age <50 years, atypical Canadian Cardiovascular Society angina class, absence of ST-segment change on electrocardiogram, lifelong nonsmoking, and absence of diabetes and hyperlipidemia) were associated with the angiographic finding of “no or nonobstructive CAD.” The c-statistics for the derivation model were 0.76 and 0.74 using the validation dataset. In conclusion, this simple clinical prediction tool, applied to patients for whom determination of coronary anatomy was clinically indicated, identifies patients who have a low likelihood of obstructive CAD. The patient population identified by this tool may represent a population best suited to a noninvasive diagnostic strategy.
copNew York, NY
pubElsevier Inc
pmid20691301
doi10.1016/j.amjcard.2010.03.061