Open AccessPrediction of coronary artery disease severity in patients referred for coronary angiography
Author(s) -
Rott David,
Benhorin Jesaia,
Keren Andre,
Baras Mario,
Leibowitz David,
Banai Shmuel
Publication year - 2005
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960280607
Subject(s) - medicine , clopidogrel , cardiology , coronary artery disease , aspirin , logistic regression , angiography , myocardial infarction , coronary angiography , predictive value of tests , coronary artery bypass surgery , framingham risk score , derivation , diabetes mellitus , predictive value , bypass surgery , radiology , artery , disease , endocrinology
Background : Diagnostic coronary angiography is oftenfol‐lowed by coronary stenting. Therapy with aspirin and clopidogrel is currently the standard treatment for patients undergoing coronary stenting. Clopidogrel loading is usually given prior to the procedure. Some pretreated patients, however, are found to have triple‐vessel disease (3 VD) or left main disease (LMD) that requires referral for coronary artery bypass graft (CABG) surgery. Surgery in patients pretreated with clopidogrel may be complicated by excessive bleeding or delayed to avoid that risk. Hypothesis : A risk factor‐based formula may predict the likelihood that patients referred for coronary angiography will have 3VD or LMD. Methods : Consecutive patients (n= 2,180) referred for coronary angiography constitute the training subset (n = 1,296) used to build the model, and the validation subset (n = 884) used to test the model. Logistic regression models selected five variables showing strong associations with the presence of 3VD or LMD: age, gender, diabetes, hypercholesterolemia, and prior myocardial infarction (MI). A formula based on these variables and on the training subset was constructed to calculate the probability of 3 VD or LMD. Results : Applying this model to the validation subset predicted 3 VD or LMD with 79% sensitivity, 53% specificity, 45% positive predictive value, and 83% negative predictive value. Conclusions : This simple formula based on five clinical variables is helpful in predicting the likelihood that patients, referred for coronary angiography, will have 3 VD or LMD. Use of this formula can help decide in which patients clopidogrel loading prior to angiography should be avoided.