Chronic stable angina probability of coronary artery disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753
Associate Editor-in-Chief: Smita Kohli, M.D.
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Overview
Once the history and physical examination is complete, it is important to assess the probability of coronary artery disease, as this helps both the physician and the patient to decide what next step in diagnosis and treatment should be taken. There have been a lot of studies emphasizing the importance of assessing pretest probability of CAD for every patient. Diamond and Forrester[1] showed in their study that age, gender and type of pain are strong predictors for the likelihood of CAD. Multiple subsequent prospective studies have confirmed their conclusion.
Pretest Probability
Definition
Pretest Probability is defined as the probability of the target disorder before the result of a diagnostic test is known. The pretest probability is especially useful for:
- deciding whether its worth testing at all(test threshold)
- selecting type of diagnostic test
- interpreting the results of a diagnostic test
- choosing whether to start therapy: a)without further testing(treatment threshold); b)while awaiting further testing
Calculating the pretest probability for coronary artery disease
First step is to categorize the type of chest pain or discomfort. This can be done as follows:
- Typical angina(definite)
- substernal chest discomfort with chracteristic quality and duration
- provoked by exercise or emotional stress
- relieved by rest or NTG
- Atypical angina(probable)-meets 2 of the above criteria
- Nonanginal pain- meets one or zero of the anginal characteristics.
Next step is to calculate the pretest probability of CAD based on age, gender and type of pain. Pretest probability can be classified into low, intermediate and high probability. A quick way to assess this is shown in Table 1.[2] [3] [4]
| Age(yrs) | Gender | Nonanginal pain | Atypical angina | Typical angina |
| 30-39 | Men | Low | Intermediate | Intermediate |
| Women | Low | Low | Intermediate | |
| 40-49 | Men | Intermediate | Intermediate | High |
| Women | Low | Low | Intermediate | |
| 50-59 | Men | Intermediate | Intermediate | High |
| Women | Low | Intermediate | Intermediate | |
| 60-69 | Men | Intermediate | Intermediate | High |
| Women | Intermediate | Intermediate | High |
Table 1: Pretest probability for coronary artery disease. Low probability: <10%; intermediate probability: 10-90%; high probability: >90%.
(Percent here represents the percent with CAD on catheterization).
References
- ↑ Improved interpretation of a continuous variable in diagnostic testing: probabilistic analysis of scintigraphic rest and exercise left ventricular ejection fractions for coronary disease detection. Diamond GA, Forrester JS. Am Heart J. 1981 Aug;102(2):189-95. PMID: 7258092
- ↑ 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. Fraker TD Jr, Fihn SD; 2002 Chronic Stable Angina Writing Committee; American College of Cardiology; American Heart Association, Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Gardin JM, O'Rourke RA, Williams SV, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW. J Am Coll Cardiol. 2007 Dec 4;50(23):2264-74. No abstract available. Erratum in: J Am Coll Cardiol. 2007 Dec 4;50(23):e1. Pasternak, Richard C [removed]. PMID: 18061078
- ↑ Evaluation of primary care patients with chronic stable angina: guidelines from the American College of Physicians. Snow V, Barry P, Fihn SD, Gibbons RJ, Owens DK, Williams SV, Weiss KB, Mottur-Pilson C; ACP; ACC Chronic Stable Angina Panel. Ann Intern Med. 2004 Jul 6;141(1):57-64. PMID: 15238371
- ↑ Probability of CAD. Diamond GA, Forrester JS. Circulation. 1982 Mar;65(3):641-2. No abstract available. PMID: 7055887
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
