{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T19:37:37Z","timestamp":1775158657890,"version":"3.50.1"},"reference-count":28,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2018,10,17]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Patients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of obstructive CAD in patients with UA referred for acute CAG.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>From 2005 to 2012, all CAGs performed at the University Hospital of North Norway, the sole provider of CAG in the region, were recorded in a registry. We included 979 admissions of UA and retrospectively collected data regarding presenting clinical parameters from patient hospital records. Obstructive CAD was defined as \u226550% stenosis and considered prognostically significant if found in the left main stem, proximal LAD or all three main coronary arteries. Characteristics were analysed by logistic regression analysis. A score was developed using ORs from significant factors in a multivariable model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The overall rate of obstructive CAD was 45%, and the rate of prognostically significant CAD was 11%. The risk criteria recommended in American College of Cardiology\/American Heart Association and European Society of Cardiology guidelines had an area under the curve (AUC) of 0.58. Adding clinical information increased the AUC to 0.77 (95% CI 0.74 to 0.80). Applying the derived score, we found that 56% (n=546) of patients had a score of &lt;13, which was associated with a negative predictive value of 95% for prognostic significant CAD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The current results suggest that CAG may be postponed or cancelled in more than half of patients with UA by improving pre-test selection criteria with the addition of clinical parameters to current guidelines.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2018-000888","type":"journal-article","created":{"date-parts":[[2018,11,2]],"date-time":"2018-11-02T00:25:21Z","timestamp":1541118321000},"page":"e000888","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6505-2640","authenticated-orcid":false,"given":"Kristina","family":"Fladseth","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"},{"name":"Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Kristensen","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Mannsverk","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thor","family":"Trovik","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrik","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo, Oslo, Norway"},{"name":"Department of Cardiology, Akershus University Hospital, L\u00f8renskog, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,11,1]]},"reference":[{"key":"2025081710370705000_5.2.e000888.1","first-page":"1","article-title":"National hospital ambulatory medical care survey: 2007 emergency department summary","volume":"26","author":"Niska","year":"2010","journal-title":"Natl Health Stat Report"},{"key":"2025081710370705000_5.2.e000888.2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.122"},{"key":"2025081710370705000_5.2.e000888.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"2025081710370705000_5.2.e000888.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2012.07.015"},{"key":"2025081710370705000_5.2.e000888.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.02.044"},{"key":"2025081710370705000_5.2.e000888.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw029"},{"key":"2025081710370705000_5.2.e000888.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.05.023"},{"key":"2025081710370705000_5.2.e000888.8","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.amjmed.2015.10.016","article-title":"Prognostic value of undetectable hs troponin T in suspected acute coronary syndrome","volume":"129","author":"Vafaie","year":"2016","journal-title":"Am J Med"},{"key":"2025081710370705000_5.2.e000888.9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jacc.2014.09.017","article-title":"2014 AHA\/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American college of cardiology\/American heart association task force on practice guidelines","volume":"64","author":"Amsterdam","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2025081710370705000_5.2.e000888.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-004425","article-title":"Should patients with acute coronary disease be stratified for management according to their risk? 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