Clinical Symptoms and Angiographic Findings of Patients Undergoing Elective Coronary Angiography without Prior Stress Testing
Bibliographic record
Abstract
Background: Many patients undergo elective coronary angiography without prior stress testing, precluding an assessment of their appropriateness for percutaneous coronary intervention (PCI). If, however, these patients have more severe angina or obstructive coronary artery disease (CAD), proceeding directly to angiography would represent efficient resource utilization. Methods: We identified patients without a prior history of obstructive CAD undergoing elective coronary angiography performed between July 2009 and March 2012 in the NCDR CathPCI Registry® and assessed for differences in angina (Canadian Cardiovascular Society [CCS] class) and severity of obstructive CAD (70% stenosis in an epicardial or 50% in a left main coronary artery) in those with and without pre-procedural stress testing. Given the large sample size, differences were considered clinically meaningful if the standardized difference was 10%. To further understand whether proceeding to coronary angiography without prior stress testing was justified because of a high clinical pre-test probability for CAD, we also compared the frequency of obstructive CAD. Results: Of 403,182 patients undergoing elective coronary angiography, nearly half (49.7%) were performed without prior stress testing. Patients without prior stress testing were more frequently asymptomatic (CCS class 0), as compared with those who had prior stress testing (40.5% vs. 28.7%; standardized difference 19.1%). There were no meaningful differences in the frequency of proximal LAD (5.1 % in no stress test group vs. 6.4% in stress test group; standardized difference 5.7%), left main (2.9% vs. 3.5%; standardized difference 3.5%) or 3-vessel CAD (4.4% vs. 6.1%; standardized difference 6.0%) between the 2 groups. Moreover, the likelihood of obstructive CAD in patients undergoing coronary angiography without prior stress testing was 18.0%, as compared with 43.0%, 22.9%, and 12.6% for those with stress testing showing severe, moderate, and mild ischemia. Conclusion: In elective angiography, proceeding to coronary angiography without prior stress testing was not associated with greater symptoms, higher-risk coronary anatomy, nor a greater presence of obstructive CAD. Many angiographic procedures might be avoided with pre-procedural stress testing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".