What percent luminal stenosis should be used to define angiographic coronary artery disease for noninvasive test evaluation?
BACKGROUND
There has been controversy over what is the best angiographic luminal dimension criterion associated with ischemia for evaluating diagnostic tests. If one assumes that ST-segment depression or scores are indicators of ischemia, then whatever angiographic criteria best discriminates those with ischemic and nonischemic responses would be the best angiographic marker for ischemia. To study this, we calculated the area under the ROC curves for ST depression and scores at different angiographic cut-points in order to determine the best angiographic cut-point for defining ischemia-producing coronary disease.


METHODS
Twelve hundred and seventy-six consecutive males without prior MI with a mean age of 59 +/- 11 years who had undergone exercise testing and coronary angiography were analyzed in this study. We calculated the number of patients of this population that would be considered to have coronary artery disease at different cut-points for angiographic luminal stenosis. For example, 59% of the patients had significant CAD when disease was defined as 50% or greater coronary lumen stenosis of any coronary vessel while 49% of the patients had significant CAD when disease was defined as 70% or greater coronary lumen stenosis. Cut-points were considered between 40 to 100% coronary lumen stenosis. ROC analysis was then performed comparing ST depression and treadmill scores at each of these cut-points.


RESULTS
The cut-point for coronary lumen stenosis that returned the highest AUC for ST depression and scores was between 70 and 80% coronary luminal stenosis. However, the difference between the 50% and 75% luminal stenosis criteria was minimal.


CONCLUSIONS
It appears that the best cut-point for defining significant angiographic disease when evaluating diagnostic tests of ischemia is 75% or greater coronary luminal stenosis.
Lipinski
Michael
M
Cardiology Division (111C), VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304, USA.
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Dat
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Morise
Anthony
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Froelicher
Victor
V
D000368:Aged; D017023:Coronary Angiography / Q000592:standards*; D003327:Coronary Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D005080:Exercise Test / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve