scholarly journals Sex differences in two international guidelines for assessing obstructive coronary artery disease in symptomatic outpatients by coronary computed tomographic angiography

2021 ◽  
Author(s):  
Yahang Tan ◽  
Zhe Wang ◽  
Qian Xin ◽  
Na Li ◽  
Fang Liu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Group ◽  
Obstructive Coronary Artery Disease ◽  
Low Risk ◽  
Noninvasive Testing ◽  
Nice Guidelines ◽  
Esc Guidelines ◽  
Artery Disease

Abstract Background Low-risk individuals are unlikely to benefit from noninvasive testing, and women tend to have a lower prevalence of obstructive coronary artery disease (CAD). This study compared the performance of two current guidelines that differ by sex to assess stable chest pain outpatients, including symptom-based (2016 National Institute for Health and Care Excellence, NICE) and risk-based strategies (2019 European Society of Cardiology, ESC). Methods A total of 542 men and women outpatients referred for coronary computed tomography angiography (CCTA) at a single-centre were retrospectively included in this study. A risk assessment was calculated for each outpatient according to the NICE and ESC guidelines. Patients were classified into low-risk and high-risk groups according to each strategy. The presence of obstructive coronary artery disease was the endpoint. Net reclassification improvement (NRI) was used to assess the performance of the two strategies. Results The 2016 NICE guidelines classified 29.39% of women and 34.60% of men into the low-risk group. The 2019 ESC guidelines classified 55.56% of women and 28.14% of men into the low-risk group. The 2019 ESC guidelines had a higher predictive value for coronary artery disease compared to the 2016 NICE guidelines, with a positive NRI in men (15.55%) and women (36.59%) respectively. Conclusion The 2019 ESC guidelines offered a more accurate calculation of risk assessment than the 2016 NICE guidelines. Patient sex influenced applying the recent ESC guidelines, which would result in a significant decrease in inappropriate testing of women but an increase in appropriate noninvasive testing of men.

Pre-Liver Transplant Coronary Artery Disease Workup for Low-Risk Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 976-980
Author(s):  
Jacentha Buggs ◽  
Sadaf Aslam ◽  
Chelsea Walker ◽  
Madison Hook ◽  
Tiffany M. Matyja ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Liver Transplant ◽  
Medical Records ◽  
Low Risk ◽  
Disease Assessment ◽  
Predictive Values ◽  
Risk Patients ◽  
Artery Disease

Background Coronary artery disease (CAD) is a leading cause of mortality following orthotopic liver transplant, yet there is no standardized protocol for pre-liver-transplant coronary artery disease assessment. The main objective of this study was to determine the agreement between 2 methods of cardiac risk assessment: dobutamine stress echocardiogram (DSE) and coronary calcium score (CCS) and to determine which test was best able to predict coronary calcification in low-risk patients. Methods A retrospective study was performed using the medical records of 436 patients who received cardiac clearance for a liver transplant. A total of 152 patients’ medical records were included based on the inclusion of patients who had received both DSE and CCS. A kappa coefficient was calculated to determine the agreement between the DSE and CCS results. In addition, the positive predictive values (PPVs) of both the CCS and DSE along with cardiac catheterization indicating abdominal occlusion were analyzed to compare the accuracy of the 2 tests. Results It was determined that there was a 12% agreement between DSE results and CCS. It was found that the DSE had a PPV of 56% and the CCS had a PPV of 80%. Conclusion From this data, it was concluded that there was no agreement between the results of the CCS and the DSE. While neither the CCS nor the DSE presents an optimal method of risk assessment, the CCS had a much higher PPV and was therefore determined to be the more accurate test.

Abstract P151: Diagnostic Yield of Elective Cardiac Catheterization After an Abnormal Stress Test: A Quality Initiative Study

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Manjunath G Raju ◽  
Srikar Sidini ◽  
Joseph Gardiner ◽  
Ameeth Vedre ◽  
George S Abela
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Catheterization ◽  
Diagnostic Yield ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Noninvasive Testing ◽  
Noninvasive Test ◽  
Artery Disease

Background: Guidelines for triaging patients for cardiac catheterization recommend a risk assessment and noninvasive testing. We determined patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected coronary artery disease in our outpatient clinical center at Michigan State University. Methods: We conducted a retrospective cohort study of 133 consecutive patients who underwent elective cardiac catheterization from July 2008 through August 2010. Demographic characteristics, risk factors, symptoms and the results of noninvasive testing were correlated with the presence of obstructive coronary artery disease, which was defined as 50% or more of coronary artery stenosis. Results: The median age was 62 years with 71% men. Risk factors included diabetes 39%; hypertension 77 %; prior CAD 44% and dyslipidemia 79 %. Angina/chest pain was present in 62 % and atrial fibrillation in 7%. Patients with prior CAD receiving percutaneous coronary intervention were 34 % (20/58) as compared to 27% (20/75) without prior CAD. Noninvasive testing was performed in 78 % (104/133) of the patients. Among patients undergoing heart catheterization 53% (71/133) had obstructive coronary artery disease. A total of 97 patients had an abnormal stress test and 52% (50/97) had obstructive CAD. Associations with obstructive coronary artery disease were: male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 0.71, 3.19), older age (OR per 5-year increment, 1.21; 95% CI, 1.03, 1.42), presence of diabetes (OR= 1.51; 95% CI, 0.75, 3.06), and presence of dyslipidemia (OR=1.42; 95% CI, 0.62 to 3.29). Conclusions: Patients with a positive result on a noninvasive test were more likely to have obstructive coronary artery disease than those who did not undergo any testing but this did not achieve significance (52% vs. 48%; P=.76). A larger patient group may be required to confirm this observation. However, improved strategies for risk stratification could help increase the diagnostic yield of cardiac catheterization in routine clinical practice.

scholarly journals Association between a Genetic Risk Score Based on Single Nucleotide Polymorphisms of Coronary Artery Disease-Related Genes and Left Main Coronary Artery Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhengxi Xu ◽  
Hanning Liu ◽  
Cheng Sun ◽  
Ke Si ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Risk Score ◽  
Genetic Risk ◽  
Risk Group ◽  
Genetic Risk Score ◽  
High Risk Group ◽  
Low Risk ◽  
Artery Disease

Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Left main coronary artery disease (LMCAD) is a severe phenotype of CAD and has a genetic component. Previous studies identified 3 inflammation-related single nucleotide polymorphisms (SNPs) contributing to the development of LMCAD. We integrated these SNPs into a genetic risk score for the prediction of LMCAD. We enrolled 1544 patients with CAD between 2007 and 2011. The individual associations of the 3 SNPs with LMCAD were assessed. We then calculated the genetic risk score for each patient and stratified patients into low-risk, intermediate-risk, and high-risk categories of genetic risk. In univariable logistic regression analysis, the odds of LMCAD for the high-risk group were 2.81 (95% confidence interval [CI]: 1.72-4.60; P = 0.02) times those of the low-risk group. After adjustment for CAD-related clinical variables, the high-risk group (adjusted OR: 2.78; 95% CI: 1.69-4.58; P = 0.02) had increased odds of LMCAD when compared with the low-risk group. Comparison of model c-statistics showed greater predictive value with regard to LMCAD for the genetic risk score model than the models including single SNPs.

scholarly journals Distinct Patterns of the Autofluorescence of Body Surface: Potential Novel Diagnostic Biomarkers for Stable Coronary Artery Disease and Myocardial Infarction

2018 ◽  
Author(s):  
Xinkai Qu ◽  
Yujia Li ◽  
Yue Tao ◽  
Mingchao Zhang ◽  
Danhong Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Body Surface ◽  
Index Finger ◽  
Risk Group ◽  
Stable Coronary Artery Disease ◽  
Low Risk ◽  
Diagnostic Biomarkers ◽  
Artery Disease

AbstractSearches for new biomarkers of stable coronary artery disease (SCAD) and myocardial infarction (MI) are critical for therapeutic efficacy of the diseases. In this study we tested our hypothesis that distinct patterns of autofluorescence (AF) of skin and fingernails may become novel diagnostic biomarkers for MI and SCAD. Our study has indicated that SCAD and MI have distinct patterns of AF of their body surface: First, the AF intensity of the MI patients is significantly higher than that of the Healthy and Low-Risk group in their right and left Centremetacarpus, Ventroforefinger, Dorsal Index Finger and Ventribrachium, while the AF intensity of the SCAD patients is significantly higher than that of the Healthy and Low-Risk group in their right and left Index Fingernails and Dorsal Antebrachium; and second, the AF asymmetry of the MI patients is significantly higher than that of the Healthy and Low-Risk group in their Centremetacarpus, Ventroforefinger, Index Fingernails and Dorsal Antebrachium, while the AF asymmetry of the SCAD patients is significantly higher than that of the Healthy and Low-Risk group in their Ventroforefinger, Dorsal Index Finger, Dorsal Centremetacarpus and Index Fingernails. Moreover, the AF pattern of acute ischemic stroke is markedly different from those of SCAD and MI. The oxidative stress in the plasma of the MI and SCAD patients may cause the increased AF by altering the AF of keratins. Collectively, our study has indicated that SCAD and MI patients have distinct patterns of AF changes, which may become novel diagnostic biomarkers for SCAD and MI.

Gender Differences in Non-Obstructive Coronary Artery Disease

2020 ◽  
Vol 26 ◽  
Author(s):  
Maria Bergami ◽  
Marialuisa Scarpone ◽  
Edina Cenko ◽  
Elisa Varotti ◽  
Peter Louis Amaduzzi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Gender Differences ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Ischemic Heart ◽  
Current Evidence ◽  
Artery Disease

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

scholarly journals OCT Findings in MINOCA

2021 ◽  
Vol 10 (13) ◽  
pp. 2759
Author(s):  
Krzysztof Bryniarski ◽  
Pawel Gasior ◽  
Jacek Legutko ◽  
Dawid Makowicz ◽  
Anna Kedziora ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Imaging Modality ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Morphological Characteristics ◽  
Artery Dissection ◽  
Plaque Disruption ◽  
Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

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