Journal Article Ahead of print 1 citation
PubMed: 42489631 DOI: 10.1093/eurheartj/ehag464
Standard clinical and stress electrocardiogram variables to exclude left main and left main-equivalent disease: the MASTER study.
Eur Heart J
Authors: Marco De Carlo, Marco Andrea Malanima, Laura Baglietto, Lorenzo Bazan, Sergio Berti, Paolo Calabrò, Luca Carmisciano, Alberto Ranieri De Caterina, Simona Fabozzo, Marco Fornili, Andrea Ghisletti, Elias Hellou, Gaetano Antonio Lanza, Nastasia Mancini, Cristiano Massacesi, Danilo Neglia, Maria Concetta Pastore, Giuseppe Patti, Saverio Tremamunno, Giampiero Vizzari, William S Weintraub, Amir Lerman, Pier Luigi Temporelli, Raffaele De Caterina
Affiliations
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
- Cardiology Division, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy.
- Cardiology Division, Fondazione Toscana 'Gabriele Monasterio', Massa, Italy.
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy.
- Cardiology Department, ASL 2 Abruzzo Lanciano-Vasto-Chieti, Chieti, Italy.
- Cardiovascular Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.
- Center for Biostatistics, Informatics and Data Science (CBIDS), MedStar Health Research Institute, Washington, DC, USA.
- Division of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy.
Abstract
BACKGROUND AND AIMS
A simple diagnostic method able to reliably exclude left main (LM) coronary artery disease (CAD) or LMCAD-equivalent would expand implementation of an initial non-invasive strategy in patients with chronic coronary syndrome (CCS). This study assessed the diagnostic utility of an approach using clinical and ECG stress testing (EST) variables in excluding LMCAD/LMCAD-equivalent in CCS patients.
METHODS
In a multicentre case-control study, CCS patients undergoing invasive coronary angiography (CAG) after a maximal EST were evaluated. Cases were patients with angiographic ≥ 50% LM stenosis or ≥70% stenosis of both proximal left anterior descending and proximal circumflex arteries, matched with similar patients without them (controls) in a 1:3 ratio. A risk model developed through logistic regression was internally and externally validated.
RESULTS
Three hundred and thirty-five cases were matched with 797 controls. The model area under the curve (AUC) was .78. Assuming LMCAD prevalence of 5% and a misclassification cost ratio of 1:100 (ratio of cost of performing CAG in a control to cost of not performing CAG in a case), negative predictive value was 98.2%. Thus, CAG could be safely avoided in 41% of patients, missing one LMCAD/LMCAD-equivalent diagnosis for every 58 CAGs safely spared in patients without them.
CONCLUSIONS
Among CCS patients, LMCAD/LMCAD-equivalent can be excluded with high negative predictive value through a model based on clinical and EST parameters, allowing initial non-invasive management of most patients able to exercise. This approach is potentially useful particularly in communities where access to computed tomography coronary angiography is limited.
MeSH
Coronary Angiography, Constriction, Pathologic, Stress, Physiological, Angiography, Predictive Value Of Tests, Arteries, Cardiology