title: Observer reproducibility and validity of systems for clinical classification of angina pectoris: comparison with radionuclide imaging and coronary angiography.
abstract: OBJECTIVE
  To assess reproducibility and validity of clinical classification of angina pectoris (AP) patients.
  
  
  METHODS
  Fifty-six patients scheduled for coronary angiography because of stable AP were classified by two independent observers with regard to (i) type and (ii) severity of chest pain (Canadian Cardiovascular Society, CCS) and (iii) cardiac functional status (New York Heart Association, NYHA). Myocardial perfusion imaging (MPI) was performed in 55 including measurement of ejection fraction in 46, angiography was undertaken in 51.
  
  
  RESULTS
  Observers agreed 100% on the presence (n = 45) or absence (n = 11) of angina. They agreed in 52 (93%), 48 (86%), and 42 (75%) patients with regard to type of pain, CCS grade, and NYHA class, respectively. In the remaining patients, they disagreed by one class only. The positive and negative predictive values of typical/atypical angina for perfusion abnormalities and coronary disease were 55%/82% and 53%/ 82%, respectively.
  
  
  CONCLUSIONS
  Observer agreement was excellent for presence, type, and severity of chest pain but moderate with regard NYHA class. Clinical judgment could not predict with reasonable accuracy abnormal perfusion or coronary artery disease.
authors.affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. h.wulff@nikkb.dk
authors.forename: Henrik Wulff
authors.initials: HW
authors.lastname: Christensen
authors.forename: Torben
authors.initials: T
authors.lastname: Haghfelt
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.forename: Allan
authors.initials: A
authors.lastname: Johansen
authors.forename: Poul Flemming
authors.initials: PF
authors.lastname: Høilund-Carlsen
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi