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Diagnostic yield of invasive coronary angiography in a uk district general hospital.

Session Poster session 1

Speaker Floyd Pierres

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : A Rauf (London,GB), S J Denny (London,GB), F Pierres (London,GB), A Jackson (London,GB), N Papamichail (London,GB), A Pavlidis (London,GB), K Alfakih (London,GB)

A. Rauf1 , S.J. Denny1 , F. Pierres1 , A. Jackson1 , N. Papamichail1 , A. Pavlidis1 , K. Alfakih1 , 1Lewisham Healthcare NHS Trust - London - United Kingdom ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 200-201

Introduction: Invasive coronary angiography (ICA) remains the gold standard for the diagnosis of patients with stable coronary artery disease (CAD) and acute coronary syndromes (ACS). A large American registry in 2010 demonstrated a low diagnostic yield.1 Furthermore, In 2010 UK NICE guidelines recommended that patients with chest pain and high pre-test probability (PTP) of CAD, should go directly to ICA. Cardiac CT and functional imaging tests were recommended for patients with low and intermediate PTP respectively.

Purpose: Assess the diagnostic yield of ICA in stable chest pain and ACS.

Method: We examined our catheter lab database for all patients who had ICA, over a 12 month period, for new onset chest pain and ACS. We classified patients into 1) severe CAD 2) moderate CAD and 3) normal coronaries and mild CAD.

Results: In total, 707 underwent ICA (mean age 64 and 56% male). Of these, 457 were for stable chest pain and 250 were for ACS. The yield of severe CAD for the whole cohort was 41%. The yield was much higher in patients with ACS with 55% found to have severe CAD. The yield for patients with stable chest pain was lower with only 33% found to have severe CAD. Within the stable chest pain group, 330 patients (72%) were referred directly to ICA without any prior non-invasive test (such as Cardiac CT or functional tests) and of these, 30% had severe CAD.

Conclusion: We found a relatively low yield of severe CAD in patients with stable chest pain. The reasons for this are a combination of lower prevalence of CAD in current primary care populations combined with the UK NICE guidelines recommending that all patients with high PTP should have ICA using a PTP risk score that has recently been shown to overestimate risk of CAD.

Pie charts demonstrating severity of CAD

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