Observer reproducibility and validity of systems for clinical classification of angina pectoris: comparison with radionuclide imaging and coronary angiography.
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.
Christensen
Henrik Wulff
HW
Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. h.wulff@nikkb.dk
Haghfelt
Torben
T
Vach
Werner
W
Johansen
Allan
A
Høilund-Carlsen
Poul Flemming
PF
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
D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi