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.
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.
In patients with ST‐T changes, LVGLS, male sex, and typical chest pain independently predict the presence of CAD, while LVGLS is also strongly associated with disease severity.
Preliminary findings suggest CSG may serve as a triage tool before CCTA or cardiology referral before coronary computerized tomography angiography referral, and higher sensitivity than resting ECG for detecting coronary plaque is demonstrated.
Rafael A. Guillén-Marmolejos, R. Núñez-Musa, A. Núñez-Selles et al.· Frontiers in Cardiovascular...· 0 citations
Routinely available ECG-derived P-wave dispersion and echocardiographic LAVI are independent, complementary predictors of MACE in CAD patients, and integrating these two parameters into a simple risk model significantly enhances risk discrimination and reclassification, providing a practical, cost-effective tool for individualized management.
Qin Wu, Gang Chen, Jian Chang· Frontiers in Medicine· 0 citations
Background Assessment of Left Main Coronary Artery (LMCA) stenosis is critical due to its prognostic significance. LMCA cross-sectional area in Coronary Computed Tomography Angiography (CCTA) can provide a non-invasive alternative, but data on its correlation with IVUS remain limited, particularly in different ethnic groups. This study aimed to evaluate CT LM-CSA in determining significant left main stenosis compared to IVUS-MLA in Iranian patients. Methods We included patients who underwent IVUS for LM stenosis evaluation and had CCTA performed within a maximum of 90 days before IVUS. LM-CSA measured at the narrowest segment on CCTA and MLA obtained via IVUS. Correlation assessed using Pearson’s coefficient; agreement evaluated with Bland–Altman analysis. Receiver operating characteristic (ROC) analysis determined the optimal LM-CSA cut-off. Results Forty-five patients were included (mean age 59.2 ± 10.1 years; 60% male). IVUS-defined significant LMCA stenosis (MLA <6.0 mm²) was present in 33.3% patients. Baseline characteristics were similar between groups. CCTA-derived LM-CSA showed a strong correlation with IVUS-derived MLA (r = 0.93, p < 0.001). A CT-derived LM-CSA cut-off of 6.2 mm² identified for predicting significant stenosis, yielding 95.6% diagnostic accuracy and an AUC of 0.94 (95% CI: 0.86–1.00), with sensitivity of 88.2% (95% CI: 63.6–98.5%), specificity of 100% (95% CI: 87.7–100%), positive predictive value of 100% (95% CI: 78.2–100%), and negative predictive value of 93.3% (95% CI: 77.9–99.2%). Conclusions CCTA LM-CSA is a reliable non-invasive metric for LMCA stenosis assessment. The optimized cut-off provides a threshold derived in an Iranian cohort that requires further validation before it can be used to guide deferral of invasive procedures.
Mahdi Zahedi, P. Eini, M. Alemzadeh-Ansari et al.· European Journal of Radiolog...· 0 citations
BACKGROUND
Evidence regarding the role of N-terminal pro-brain natriuretic peptide (NTproBNP) in chronic coronary syndrome (CCS) remains limited. We aimed to investigate the association between plasma NTproBNP levels and the presence and extent of coronary artery disease (CAD) in a prospective real-world cohort.
METHODS
This prospective observational cross-sectional study included 676 consecutive patients (mean age 67 ± 7 years; 20% women) referred for elective coronary angiography for suspected CCS, as part of the BNP-CAD study (ClinicalTrials.govNCT07013344). Patients with conditions known to elevate NTproBNP were excluded. Obstructive CAD was defined as stenosis ≥70% (≥50% for the left main). Prognostically significant CAD was defined as involvement of the left main or proximal LAD artery.
RESULTS
Obstructive CAD was identified in 432 patients (64%). NTproBNP levels were significantly higher in patients with obstructive CAD compared to those without (124 vs. 96 pg/mL, p < 0.001) and increased with the number of vessels involved and degree of stenosis. After adjustment for clinical confounders and high-sensitivity troponin T, NT-proBNP remained independently associated with obstructive CAD (OR per 100 pg/mL increase: 1.18; 95% CI: 1.03-1.36; p = 0.021). Prognostically significant CAD was present in 197 patients (46% of those with obstructive CAD) and was associated with higher NT-proBNP levels (133 vs. 107 pg/mL; p = 0.006), although discriminatory performance remained modest (AUC: 0.60; 95% CI: 0.55-0.64).
CONCLUSION
NT-proBNP was independently associated with obstructive CAD and correlated with coronary disease burden. However, its modest discriminatory performance precludes its use as a stand-alone diagnostic test for high-risk coronary anatomy.
Mirko Schivalocchi, R. Mazza, C. Gaspardone et al.· International Journal of Car...· 0 citations
Aim
. To analyze the predictive potential of electrocardiographic (ECG) and echocardiographic parameters to develop predictive models for obstructive coronary atherosclerosis in patients with stable coronary artery disease (CAD).
Material and methods
. This single‑center retrospective study was conducted, analyzing data from 1005 patients with stable CAD. Based on invasive coronary angiography results, two following groups were identified: group 1‑774 patients (77%) with obstructive CAD, and group 2‑231 patients (23%) with non‑obstructive CAD. Mathematical statistics and multivariate logistic regression were used to process and analyze the data, which were used to develop predictive models for obstructive CAD.
Results
. Multistage analysis showed that ECG parameters did not have significant intergroup differences and had no predictive value for predicting obstructive CAD. In models with continuous predictors, echocardiographic parameters did not provide an acceptable level of prediction, which was achieved only after incorporating hematological factors into the model structure. SHAP‑based categorization of continuous predictors allowed us to identify following threshold values associated with an increased risk of obstructive CAD: right ventricular basal diameter ≤2,6 cm, right atrial anteroposterior diameter (≤5,2 cm) and left atrial anteroposterior diameter (≤5 cm), fibrinogen ≥3,6 g/L, and lymphocytes ≤29%. The algorithm with categorical factors outperformed the continuous predictor model in terms of predictive quality.
Conclusion
. ECG parameters had no value for predicting obstructive CAD. The obstructive CAD prognostic model based on categorical predictors demonstrated higher accuracy and reliability than the model with continuous predictors.
V. Mostovaya, A. S. Pogiba, K. I. Shahgel'dyan et al.· Russian Journal of Cardiolog...· 0 citations
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