JAMA Cardiology – Effect of the Presence and Type of Angina on Cardiovascular Events in Patients Without Known Coronary Artery Disease Referred for Elective Coronary Angiography

This study describes the characteristics of patients referred for typical, atypical, or no angina and examines the associations between angina type, pre–cardiac catheterization stress test results, and burden of coronary atherosclerosis identified on coronary angiography.

Source: JAMA Network | JAMA Cardiology | Effect of the Presence and Type of Angina on Cardiovascular Events in Patients Without Known Coronary Artery Disease Referred for Elective Coronary Angiography

In this short research letter we find further lack of utility for stress tests in the manner for which we are currently using them for risk stratification. The authors categorized patients referred for catheterization without known CAD to groups based on chest pain symptoms of: typical, atypical, or absent. They then looked at their stress test results, categorized as positive or negative, and found that a negative stress test did not help predict those without obstructive CAD on catheterization. Specifically, patients with typical angina symptoms and a negative stress test were the MOST likely to have obstructive CAD (74%). Clearly limited by the nature of the data presented, and the limited information given regarding the methodology in this research letter, it does further raise doubts regarding the utility of stress testing to risk stratify patients for CAD.

HT to Jeremy Fried for the observation quoted above. Source: Research and Reviews R&R in the FastLane | LITFL: Life in the Fast Lane Medical Blog

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