{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T02:46:06Z","timestamp":1794624366803,"version":"4.9.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>A simple diagnostic method able to reliably exclude left main (LM) coronary artery disease (CAD) or LMCAD-equivalent would expand implementation of an initial non-invasive strategy in patients with chronic coronary syndrome (CCS). This study assessed the diagnostic utility of an approach using clinical and ECG stress testing (EST) variables in excluding LMCAD\/LMCAD-equivalent in CCS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a multicentre case-control study, CCS patients undergoing invasive coronary angiography (CAG) after a maximal EST were evaluated. Cases were patients with angiographic \u2265 50% LM stenosis or \u226570% stenosis of both proximal left anterior descending and proximal circumflex arteries, matched with similar patients without them (controls) in a 1:3 ratio. A risk model developed through logistic regression was internally and externally validated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three hundred and thirty-five cases were matched with 797 controls. The model area under the curve (AUC) was .78. Assuming LMCAD prevalence of 5% and a misclassification cost ratio of 1:100 (ratio of cost of performing CAG in a control to cost of not performing CAG in a case), negative predictive value was 98.2%. Thus, CAG could be safely avoided in 41% of patients, missing one LMCAD\/LMCAD-equivalent diagnosis for every 58 CAGs safely spared in patients without them.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among CCS patients, LMCAD\/LMCAD-equivalent can be excluded with high negative predictive value through a model based on clinical and EST parameters, allowing initial non-invasive management of most patients able to exercise. This approach is potentially useful particularly in communities where access to computed tomography coronary angiography is limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehag464","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T11:40:03Z","timestamp":1780141203000},"source":"Crossref","is-referenced-by-count":3,"title":["Standard clinical and stress electrocardiogram variables to exclude left main and left main-equivalent disease: the MASTER study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5763-9804","authenticated-orcid":false,"given":"Marco","family":"De Carlo","sequence":"first","affiliation":[{"name":"Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Pisa University Hospital , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1464-1145","authenticated-orcid":false,"given":"Marco Andrea","family":"Malanima","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8193-7529","authenticated-orcid":false,"given":"Laura","family":"Baglietto","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4801-9996","authenticated-orcid":false,"given":"Lorenzo","family":"Bazan","sequence":"additional","affiliation":[{"name":"Cardiology Division, Cardiothoracic and Vascular Department, Pisa University Hospital , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5244-0556","authenticated-orcid":false,"given":"Sergio","family":"Berti","sequence":"additional","affiliation":[{"name":"Cardiology Division, Fondazione Toscana \u2018Gabriele Monasterio\u2019 , Massa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5018-830X","authenticated-orcid":false,"given":"Paolo","family":"Calabr\u00f2","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019 , Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6263-3864","authenticated-orcid":false,"given":"Luca","family":"Carmisciano","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4470-4208","authenticated-orcid":false,"given":"Alberto Ranieri","family":"De Caterina","sequence":"additional","affiliation":[{"name":"Cardiology Division, Fondazione Toscana \u2018Gabriele Monasterio\u2019 , Massa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Fabozzo","sequence":"additional","affiliation":[{"name":"Cardiology Division, Cardiothoracic and Vascular Department, Pisa University Hospital , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5713-3926","authenticated-orcid":false,"given":"Marco","family":"Fornili","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0529-390X","authenticated-orcid":false,"given":"Andrea","family":"Ghisletti","sequence":"additional","affiliation":[{"name":"University of Eastern Piedmont, Maggiore della Carit\u00e0 Hospital , Novara ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0705-9721","authenticated-orcid":false,"given":"Elias","family":"Hellou","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-6653","authenticated-orcid":false,"given":"Gaetano Antonio","family":"Lanza","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences, Universit\u00e0 Cattolica del Sacro Cuore , Rome ,","place":["Italy"]},{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. 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