Official websites use. Share sensitive information only on official, secure websites. Noninvasive stress imaging or an exercise tolerance test ETT are the most common methods to detect obstructive coronary artery disease, though stress test markers of LMD remain ill-defined.
We sought to identify markers of LMD as detected on coronary computed tomography angiography CCTA , using clinical and stress testing parameters. Stress tests were read by core laboratories. Prior coronary artery bypass grafting was an exclusion. In a stepped multivariate model, we identified predictors of LMD, first without and then with stress testing parameters.
The models were weakly predictive of LMD C-index 0. For most patients with moderate or severe ischemia, anatomic imaging is needed to rule out LMD. Keywords: Stress testing, coronary CT angiography, stable ischemic heart disease, coronary artery disease. Models for LMD demonstrated suboptimal prediction overall. Thus for most patients with moderate or severe ischemia, exclusion of LMD will require anatomic imaging with either CCTA or coronary angiography.
The ISCHEMIA trial, which randomized patients with moderate or severe ischemia to guideline-directed medical therapy vs guideline-directed medical therapy plus optimal revascularization, showed no statistical difference between the groups for the primary composite outcome or the secondary outcome of cardiovascular death or myocardial infarction. Hence, detection of LMD during the initial evaluation of patients with myocardial ischemia is important as revascularization remains the guideline-recommended management strategy in these patients.
Previous studies that evaluated clinical or functional tests i. In brief, the ISCHEMIA cohort comprised patients with stable ischemic heart disease and moderate or severe ischemia on clinically indicated stress imaging or severe ischemia on exercise tolerance test ETT as determined by enrolling sites and read later at centralized trial core laboratories. Patients were eligible if they were clinically stable, including stable angina or silent ischemia.
