title: Diagnostic yield of coronary angiography in patients with acute chest pain: role of noninvasive test.
abstract: OBJECTIVE
  This study investigated the diagnostic yield of invasive coronary angiography (CAG) and the impact of noninvasive test (NIV) in patients presented to emergency department (ED) with acute chest pain.
  
  
  METHODS
  Patients 50 years or older who visited ED with acute chest pain and underwent CAG were identified retrospectively. Those with ischemic electrocardiogram, elevated cardiac enzyme, known coronary artery disease (CAD), history of cardiac surgery, renal failure, or allergy to radiocontrast were excluded. Diagnostic yields of CAG to detect significant CAD or differentiate the need for revascularization were analyzed according to whether NIV was performed and its result.
  
  
  RESULTS
  Among the total 375 consecutive patients, significant CAD was observed in 244 (65.1%). Diagnostic yields of CAG were higher in patients who underwent NIV before CAG, but the discriminative effect was modest (59.7% vs 70.7% [P = .026] for detection of CAD; 45.0% vs 50.5% [P = .285] for revascularization). Positive results of NIV were significantly associated with the presence of CAD and the need for revascularization, when compared with patients without NIV or patients with negative results (P < .001, respectively).
  
  
  CONCLUSIONS
  The diagnostic yield of CAG was only 65% in low- to intermediate-risk ED patients with acute chest pain. Performing of NIV provided only modest improvement in diagnostic yield of CAG. The unexpectedly low diagnostic yield might be attributable to the underuse of NIV and misinterpretation of physicians. We suggest the use of NIV as a gatekeeper to discriminate patients who require CAG and/or revascularization, and for this, better risk stratification and appropriate application of NIV are required.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: In-Chang
authors.initials: IC
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. Electronic address: kimdamas@snu.ac.kr.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Seung-Pyo
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Hyung-Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Dae-Won
authors.initials: DW
authors.lastname: Sohn
mesh_terms: D059787:Acute Pain / Q000000981:diagnostic imaging / Q000209:etiology; D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon