scholarly journals The Association Between Pretest Probability of Coronary Artery Disease and Stress Test Utilization and Outcomes in a Chest Pain Observation Unit

2014 ◽  
Vol 21 (4) ◽  
pp. 401-407 ◽  
Author(s):  
Anthony M. Napoli
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Pretest Probability ◽  
Observation Unit ◽  
Artery Disease

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

Cardiology ◽  
2015 ◽  
Vol 133 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Mathias Sørgaard ◽  
Jesper James Linde ◽  
Klaus Fuglsang Kofoed ◽  
Jørgen Tobias Kühl ◽  
Henning Kelbæk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Stress Test ◽  
Photon Emission ◽  
Acute Onset ◽  
Emission Computed Tomography ◽  
Artery Disease

Objectives: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. Methods: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. Results: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). Conclusions: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

scholarly journals Relationship of Stress Test Findings to Anatomic or Functional Extent of Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Demetrios Doukas ◽  
Sorcha Allen ◽  
Amy Wozniak ◽  
Siri Kunchakarra ◽  
Rina Verma ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Testing ◽  
Stress Test ◽  
Exercise Duration ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Artery Disease

Background. In the United States, functional stress testing is the primary imaging modality for patients with stable symptoms suspected to represent coronary artery disease (CAD). Coronary computed tomography angiography (CTA) is excellent at identifying anatomic coronary artery disease (CAD). The application of computational fluid dynamics to coronary CTA allows fractional flow reserve (FFR) to be calculated noninvasively (FFRCT). The relationship of noninvasive stress testing to coronary CTA and FFRCT in real-world clinical practice has not been studied. Methods. We evaluated 206 consecutive patients at Loyola University Chicago with suspected CAD who underwent noninvasive stress testing followed by coronary CTA and FFRCT when indicated. Patients were categorized by stress test results (positive, negative, indeterminate, and equivocal). Duke treadmill score (DTS), METS, exercise duration, and chest pain with exercise were analyzed. Lesions ≥ 50 % stenosis were considered positive by coronary CTA. FF R CT < 0.80 was considered diagnostic of ischemia. Results. Two hundred and six patients had paired noninvasive stress test and coronary CTA/FFRCT results. The median time from stress test to coronary CTA was 49 days. Average patient age was 60.3 years, and 42% were male. Of the 206 stress tests, 75% were exercise (70% echocardiographic, 26% nuclear, and 4% EKG). There were no associations of stress test results with CAD > 50 % or FF R CT < 0.80 ( p = 0.927 and p = 0.910 , respectively). Of those with a positive stress test, only 30% (3/10) had CAD > 50 % and only 50% (5/10) had FF R CT < 0.80 . Chest pain with exercise did not correlate with CAD > 50 % or FF R CT < 0.80 ( p = 0.66 and p = 0.12 , respectively). There were no significant correlations between METS, DTS, or exercise duration and FFRCT ( r = 0.093 , p = 0.274 ; r = 0.012 , p = 0.883 ; and r = 0.034 , p = 0.680 ; respectively). Conclusion. Noninvasive stress testing, functional capacity, chest pain with exercise, and DTS are not associated with anatomic or functional CAD using a diagnostic strategy of coronary CTA and FFRCT.

scholarly journals Machine learning aids clinical decision making in patients presenting with angina and non-obstructive coronary artery disease

2021 ◽  
Author(s):  
Ali Ahmad ◽  
Michal Shelly-Cohen ◽  
Michel T Corban ◽  
Dennis H Murphree ◽  
Takumi Toya ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Microvascular Dysfunction ◽  
Clinical Guidance ◽  
Flow Reserve ◽  
Artery Disease ◽  
Functional Stress

Abstract Aims The current gold-standard comprehensive assessment of coronary microvascular dysfunction (CMD) is through a limited-access invasive catheterization lab procedure. We aimed to develop a point-of-care tool to assist clinical guidance in patients presenting with chest pain and/or an abnormal cardiac functional stress test and with non-obstructive coronary artery disease (NOCAD). Methods and Results This study included 1,893 NOCAD patients (&lt;50% angiographic stenosis) who underwent CMD evaluation as well as an ECG up to 1-year prior. Endothelial-independent CMD was defined by coronary flow reserve (CFR)≤2.5 in response to intracoronary adenosine. Endothelial-dependent CMD was defined by a maximal percent increase in coronary blood flow (%ΔCBF) ≤50% in response to intracoronary acetylcholine infusion. We trained algorithms to distinguish between the following outcomes: CFR ≤ 2.5, %ΔCBF ≤ 50, and the combination of both. Two classes of algorithms were trained, one depending on ECG waveforms as input, and another using tabular clinical data. Mean age was 51 ± 12 years and 66% were females (n = 1,257). AUC values ranged from 0.49–0.67 for all the outcomes. The best performance in our analysis was for the outcome CFR ≤ 2.5 with clinical variables. AUC and accuracy were 0.67 and 60%. When decreasing the threshold of positivity, sensitivity and NPV increased to 92% and 90% respectively, while specificity and PPV decreased to 25% and 29% respectively. Conclusion An AI-enabled algorithm may be able to assist clinical guidance by ruling out CMD in patients presenting with chest pain and/or an abnormal functional stress test. This algorithm needs to be prospectively validated in different cohorts.

Abstract 18043: Factors That Influence the Decision for Ischemic Work-up in Hypertensive Emergency

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Obiora Maludum ◽  
Kenechukwu Mezue ◽  
Sylvia Biso ◽  
Mary Rodriguez-Ziccardi ◽  
Talal Alnabelsi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Troponin I ◽  
Medical Center ◽  
Stress Test ◽  
Significant Coronary Artery Disease ◽  
Artery Disease ◽  
Work Up ◽  
To Receive

Background: Hypertensive emergencies (HE) account for 3% of emergency room hospitalizations and it is estimated that 1-2% of America’s 50 million hypertensive patients will have at least one occurrence of HE in their lifetime. Recent studies have shown that cardiac troponin-I is elevated in a third of patients with HE, however the pathophysiology and significance of this elevation is still being explored. We tried to look at different factors that influence the decision to do ischemic work up in patients with HE. Method: Patients admitted to Albert Einstein Medical Center from 01/01/2005 to 08/30/2014 with a diagnosis of HE were included in this retrospective study. Patients were divided into two groups: those who had either cardiac catheterization or stress test, and those who had no ischemic work up. Demographic and clinical variables were collected. A cumulative risk score for coronary artery disease was calculated by assigning 1 point for each risk factor. Results: There were total of 187 patients with HE of which only 37 had ischemic work up. 20 out of the 37 patients who had ischemic work up had chest pain. Of the 20 patients only 3 were found to have significant coronary artery disease. Comparisons between the demographics and clinical predictors in both groups are shown in the table. Multivariate analysis shows chest pain to independently predict which patients were more likely to receive an ischemic work up (OR=4.7; 95% CI 1.6 to 7.6; p=0.001). Conclusion: In the setting of HE, our study shows that chest pain was the only single factor that independently predicts which HE patients are more likely to receive an ischemic work up. Elevated troponins or EKG changes alone were not found to independently predict the decision to perform an ischemic work up. This may reflect the pattern of clinical practice at our center. Large multi-center studies might be needed to explore this further and also assess the clinical outcomes of this decision making process.

scholarly journals Exercise Stress Test Utility in Patients with Chest Pain Presumed to be of Cardiac Origin

2013 ◽  
Vol 12 (3) ◽  
pp. 146-150
Author(s):  
Philippa Bennett ◽  
◽  
Philip Dyer ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Stress Tests ◽  
Prognostic Information ◽  
Artery Disease

Introduction: NICE stated exercise stress tests (EST) should not be used to diagnose obstructive coronary artery disease in patients presenting with chest pain presumed to be of cardiac origin. Methods: A retrospective review of 209 patients with presumed cardiac chest pain was done. EST results, GRACE scores and need for invasive coronary angiogram (ICA) were analysed to predict the need for readmission, intervention and future events. Results: The sensitivity of the EST in identifying obstructive coronary artery disease was 70%. The EST, ICA and the GRACE 6-month mortality had a 77%, 70% and 81% negative predictive value (NPV) for readmission respectively. Conclusion: EST, GRACE scores and ICA are useful in providing prognostic information but are poor predictors of readmission. Follow up and education programmes are needed to reduce this burden.

scholarly journals COMPARATIVE STUDY OF COMPUTERIZED TOMOGRAPHY CORONARY ANGIOGRAPHY (CTCA) VS.TREADMILL STRESS TEST (TMT) IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE

2020 ◽  
pp. 1-5
Author(s):  
Ameta Deepak ◽  
Sharma Mukesh ◽  
Singh Pal Shalinder ◽  
Yadav Sushil
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Suspected Coronary Artery Disease ◽  
Negative Group ◽  
Atypical Chest Pain ◽  
Obstructive Lesion ◽  
Important Diagnostic Tool ◽  
Artery Disease

Background: There are few studies that compared CTCA in patients presenting with chest pain, probably ischaemic (i.e., atypical) with negative or inconclusive TMT in outpatient department. Objective: To assess 64-slice CTCA findings in patients with suspected ischaemic chest pain and negative or inconclusive TMT. Methodology: Enrolled patients underwent TMT and classified as TMT negative or inconclusive patients. These patients underwent CTCA and findings were analysed. Results: 50 patients completed the study protocol. Of these, 31 (62%) were TMT negative and 19 (38%) were TMT inconclusive. CTCA showed obstructive CAD in 19 (38%) patients; 7 (36%) with negative TMT and 12 (63%) with inconclusive TMT. Overall, CTCA was more predictive of diagnosing obstructive lesion in TMT inconclusive group as compared to TMT negative group. Conclusion: In patients with atypical chest pain with negative or non-diagnostic TMT, CTCA provides an important diagnostic tool for rapid triaging of such patients.

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