title: Assessment of the new appropriate use criteria for diagnostic catheterization in the detection of coronary artery disease following noninvasive stress testing.
abstract: BACKGROUND
  Appropriate use criteria (AUC) for diagnostic catheterization (DC) developed by the American College of Cardiology Foundation (ACCF) and other professional societies were recently published. These criteria have yet to be examined thoroughly using existing DC databases.
  
  
  RESULTS
  New York State's Cardiac Diagnostic Catheterization Database was used to identify patients undergoing DC "for suspected coronary artery disease (CAD)" in 01/2010-06/2011 who underwent noninvasive stress testing. Patients rated for appropriateness using symptoms and stress test results were examined to determine the percentage with obstructive CAD and to explore the benefit of adding Global Risk Score (GRS) to the AUC. Of the 4432 patients who could be rated, 1530 (34.5%) had obstructive CAD, which varied from 22% for patients rated inappropriate to 47% for patients rated appropriate. Of all patients with low risk stress test results/no symptoms, all of whom were rated "inappropriate" for DC, only 8% of those patients with low GRS had obstructive CAD, whereas 44% of the patients with high GRS had obstructive CAD.
  
  
  CONCLUSIONS
  Global Risk Score improved the ability of symptoms and stress test results to identify obstructive CAD in patients with "suspected CAD" with prior stress tests, and it might be helpful to add GRS to the DC AUC for those patients. These findings should be regarded as hypothesis generating unless/until they can be confirmed by other data bases.
authors.affiliation: University at Albany, State University of New York, Albany, NY, United States. Electronic address: elh03@health.state.ny.us.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.affiliation: University at Albany, State University of New York, Albany, NY, United States.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Samadashvili
authors.affiliation: University at Albany, State University of New York, Albany, NY, United States.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Cozzens
authors.affiliation: Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Gary
authors.initials: G
authors.lastname: Walford
authors.affiliation: Boston Medical Center, Boston, MA, United States.
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.affiliation: Mayo Clinic, Rochester, MN, United States.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.affiliation: United Health Services, Binghamton, NY, United States.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Stamato
authors.affiliation: Albany Medical Center, Albany, NY, United States.
authors.forename: Ferdinand J
authors.initials: FJ
authors.lastname: Venditti
authors.affiliation: Medical University of Ohio, Toledo, OH, United States.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Gold
authors.affiliation: Mt. Sinai Medical Center, New York, NY, United States.
authors.forename: Samin
authors.initials: S
authors.lastname: Sharma
authors.affiliation: St. Joseph's Health System, Atlanta, GA, United States.
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis* / Q000453:epidemiology; D058070:Asymptomatic Diseases; D006328:Cardiac Catheterization / Q000379:methods* / Q000592:standards; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D006801:Humans; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
keywords: Appropriateness; Diagnostic catheterization; Global Risk Score; Stress tests; Symptoms