{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:56:04Z","timestamp":1772826964389,"version":"3.50.1"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Inconclusive noninvasive tests complicate the care of patients with suspected coronary artery disease, but their prevalence and impact on management, outcomes, and costs are not well described.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) patients were randomized to stress testing (n=4533) or computed tomographic angiography (CTA; n=4677). We assessed relationships between inconclusive results, subsequent testing, a composite outcome (death, myocardial infarction, or hospitalization for unstable angina), and healthcare expenditures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Overall, 8.0% of tests were inconclusive (9.7% stress, 6.4% CTA). Compared with negative tests, inconclusive tests were more often referred to a second noninvasive test (stress: 14.6% versus 8.5%, odds ratio [OR], 1.91; CTA: 36.5% versus 8.4%, OR, 5.95;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and catheterization (stress: 5.5% versus 2.4%, OR, 2.36; CTA: 23.4% versus 4.1%, OR, 6.49;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and composite outcomes were higher for both inconclusive tests (stress: 3.7% versus 2.0%, hazard ratio, 1.81,\n              <jats:italic>P<\/jats:italic>\n              =0.034; CTA: 5.0% versus 2.2%, hazard ratio, 1.85;\n              <jats:italic>P<\/jats:italic>\n              =0.044) and positive tests (stress: 8.3% versus 2.0%, hazard ratio, 3.50; CTA: 9.2% versus 2.2%, hazard ratio, 3.66;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Twenty-four\u2013month costs were higher for inconclusive tests than negative tests by $2905 (stress) and $4030 (CTA).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among patients with stable chest pain undergoing a noninvasive test, inconclusive results occurred in 6% of CTA and 10% of stress tests. Compared with those with conclusive negative tests, individuals with inconclusive results more often underwent subsequent testing, had increased medical costs, and experienced worse outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01174550.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.119.009986","type":"journal-article","created":{"date-parts":[[2020,4,9]],"date-time":"2020-04-09T09:00:23Z","timestamp":1586422823000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical and Economic Implications of Inconclusive Noninvasive Test Results in Stable Patients With Suspected Coronary Artery Disease"],"prefix":"10.1161","volume":"13","author":[{"given":"Akash","family":"Goyal","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5004-8868","authenticated-orcid":false,"given":"Neha","family":"Pagidipati","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. Larry","family":"Hill","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooke","family":"Alhanti","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James E.","family":"Udelson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H.","family":"Picard","sequence":"additional","affiliation":[{"name":"Department of Cardiology (M.H.P.), Massachusetts General Hospital, Harvard Medical School, Boston, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia A.","family":"Pellikka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (P.A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Udo","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Radiology (U.H.), Massachusetts General Hospital, Harvard Medical School, Boston, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel B.","family":"Mark","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000757"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(81)90391-x"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(03)00436-8"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0296"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMhpr061219"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415516"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2014.03.003"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.7326\/L16-0482"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.11.052"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60291-4"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805971"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2017.02.042"},{"key":"e_1_3_3_14_2","first-page":"767","article-title":"Prognostic value of dobutamine-atropine stress (99m)Tc-tetrofosmin myocardial perfusion SPECT in patients with known or suspected coronary artery disease.","volume":"43","author":"Schinkel AF","year":"2002","unstructured":"Schinkel, AF, Elhendy, A, van Domburg, RT, Bax, JJ, Roelandt, JR, Poldermans, D. 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