title: Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease.
abstract: BACKGROUND
  Guidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography.
  
  
  OBJECTIVE
  We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.
  
  
  METHODS
  We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.
  
  
  RESULTS
  A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77), age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26), diabetes (OR, 2.01; CI 95%, 1.40 - 2.90), dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07), typical angina (OR, 2.92; CI 95%, 1.77 - 4.83) and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27).
  
  
  CONCLUSIONS
  In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Francisco Flávio
authors: FF
authors: Costa Filho
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Áurea Jacob
authors: ÁJ
authors: Chaves
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Lourenço Teixeira
authors: LT
authors: Ligabó
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Eduardo Moreira Dos
authors: EM
authors: Santos
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Danillo Taiguara da
authors: DT
authors: Silva
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Marcelo Aguiar
authors: MA
authors: Puzzi
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Sérgio Luiz
authors: SL
authors: Braga
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Alexandre
authors: A
authors: Abizaid
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors: Amanda Gmr
authors: AG
authors: Sousa
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012016:Reference Values