Validity of Initial Clinical Diagnosis of Unstable Angina Based on the Invasive and Noninvasive Studies

Journal Title: International Journal of Cardiovascular Practice - Year 2016, Vol 1, Issue 1

Abstract

Introduction: A few studies have focused on diagnostic performance of residents for controlling the patients with acute chest pain referring to chest pain units. We aimed to assess diagnostic performance of cardiology residents for controlling the patients with acute chest pain, considering invasive and non-invasive diagnostic modalities as the key standards to confirm or refuse diagnosis of unstable angina. Methods: One hundred and twenty nine patients with chest pain or angina referring to chest pain unit of Modarres hospital between 2013 and 2014 were assessed. The patients were categorized into two subgroups. The first group included 23 patients who were discharged by the resident in initial evaluation because of ruling-out diagnosis of unstable angina, but were assessed non-invasively by exercise test or SPECT as key standards. The second group included 106 patients who were hospitalized and admitted to CCU by residents’ order and also were assessed invasively by coronary angiography or noninvasively by exercise test or SPECT. Results: Overall, of 129 patients, 23 were initially diagnosed not to be necessarily hospitalized and thus were discharged by resident’s order. Of those, assessing by SPECT indicated positive result in five of 19 patients and by exercise test indicated positive result in 1 of 4 patients yielding a sensitivity of 83.3%, a specificity of 17.6%, a PPV of 26.3%, a NPV of 75.0%, and an accuracy of 34.8% for assessing disease by resident. The remaining 106 patients were admitted to CCU ward in accordance with the resident’s order. Among those patients, 85 underwent coronary angiography with positive results in 53 patients. Also, SPECT was positive in 10 of 19 patients and exercise test was positive in one of two patients yielding a sensitivity of 95.3%, a specificity of 0.0%, a PPV of 59.2%, a NPV of 0.0%, and an accuracy of 57.5%. Conclusions: For patients with suspicion to unstable angina, the decision of residents in chest pain units for discharging or admitting patients suspected to unstable angina is accompanied with high sensitivity but unacceptable specificity and thus using supplement diagnostic tools such as exercise test or SPECT can be very helpful for diagnosing unstable angina.

Authors and Affiliations

Keywords

Related Articles

Syncope during pregnancy in a patient with permanent cardiac pacemaker, due to increased pacing threshold.

A 22-year-old pregnant woman referred with syncope due to pacemaker malfunction. During the second trimester of pregnancy, the right ventricular (RV) lead pacing threshold increased and led to early generator depletion....

The role of the history of coronary heart disease among second degree relatives for predicting coronary artery disease

Introduction: The history of atherosclerotic disease among second degree family members of patients as a risk factor has not been properly explained. The present study aimed to assess this role in the Iranian population....

Acute Myocardial Infarction in a Patient With Elevated ST-Segment in aVR Lead and Diffuse ST Segment Depression in Other Leads: A Case Report

ST elevation in aVR in conjunction with diffuse ST depression in precordial leads may indicate occlusion of very proximal portion of the left anterior descending artery. We present a 54-year old man, with crushing retros...

Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review

Venous obstruction is relatively frequent following permanent pacemaker or implantable cardioverter-defibrillator (ICD) implantation. However, most of them are asymptomatic. Although the exact risk factor for this compli...

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Introduction: The present study aimed at assessing the role of lesion length in predicting Fractional Flow Reserve (FFR) value for physiological evaluation of intermediate coronary lesions. Methods: In the current study,...

Download PDF file
  • EP ID EP182931
  • DOI 10.20286/ijcp-010106
  • Views 251
  • Downloads 0

How To Cite

(2016). Validity of Initial Clinical Diagnosis of Unstable Angina Based on the Invasive and Noninvasive Studies. International Journal of Cardiovascular Practice, 1(1), -. https://europub.co.uk/articles/-A-182931