Can We Predict Left Main Disease in Patients with an Abnormal Stress Test?

A large multicenter study shows only moderate discriminatory performance of predictive modeling using stress test findings.

Current guidelines recommend coronary revascularization to improve long-term survival in patients with stable coronary artery disease and left main stenosis ≥50% (left main coronary artery disease; LMCAD). Whether it is possible to reliably identify patients with (and without) LMCAD based on noninvasive stress testing is not well studied.

Using data from the multinational ISCHEMIA trial, investigators examined how well clinical factors and stress test findings predicted the presence of significant LMCAD. Trial participants had evidence of moderate or severe ischemia on provocative testing and, by protocol, underwent coronary computed tomography angiography (CCTA) prior to randomization to evaluate for possible LMCAD.

Among 5146 patients inclu…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)