{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:03:38Z","timestamp":1780085018510,"version":"3.54.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,7,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Despite more than 4\u00a0million cardiac noninvasive diagnostic tests (\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              ) being performed annually for stable coronary artery disease in the United States, it is unclear whether they are associated with downstream improvements in outcomes when compared with no testing. We sought to determine whether\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              was associated with reduced downstream major adverse cardiovascular events when compared with not testing.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We conducted a population\u2010based study of \u22481.5\u00a0million patients undergoing chest pain evaluation in Ontario, Canada. Patients were categorized into\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              and no\u2010testing groups. Cause\u2010specific proportional hazards models were used to compare the rate of major adverse cardiovascular events (composite outcome of unstable angina, acute myocardial infarction or cardiovascular mortality and each constituent) between the 2 groups after adjusting for clinically relevant covariates. The rate of the composite outcome was \u224825% lower for patients undergoing noninvasive testing (hazard ratio [HR], 0.77; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.75\u20130.79). The benefits of testing were consistent for all 3 constituents of the composite; unstable angina (HR, 0.87; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.82\u20130.93 for the\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              versus the no\u2010testing group), myocardial infarction (HR, 0.83; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.79\u20130.86 for the\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              versus the no\u2010testing group) and cardiovascular mortality (HR, 0.68; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.65\u20130.72 for the\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              versus the no\u2010testing group).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Our large population\u2010based study reports an \u224825% reduction in major adverse cardiovascular events that was independently associated with\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              in outpatients being evaluated for stable angina. This study demonstrates the prognostic importance of\n              <jats:styled-content style=\"fixed-case\">NIT<\/jats:styled-content>\n              versus no testing on the health of contemporary populations.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015724","type":"journal-article","created":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T09:01:09Z","timestamp":1593594069000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Clinical Effectiveness of Cardiac Noninvasive Diagnostic Testing in Outpatients Evaluated for Stable Coronary Artery Disease"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4058-4085","authenticated-orcid":false,"given":"Idan","family":"Roifman","sequence":"first","affiliation":[{"name":"Schulich Heart Program Sunnybrook Health Sciences Centre University of Toronto Canada"},{"name":"Institute of Health Policy Management, and Evaluation University of Toronto Canada"},{"name":"ICES Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Sivaswamy","sequence":"additional","affiliation":[{"name":"ICES Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Chu","sequence":"additional","affiliation":[{"name":"ICES Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[{"name":"Institute of Health Policy Management, and Evaluation University of Toronto Canada"},{"name":"ICES Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis T.","family":"Ko","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Sunnybrook Health Sciences Centre University of Toronto Canada"},{"name":"Institute of Health Policy Management, and Evaluation University of Toronto Canada"},{"name":"ICES Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Duke University Medical Centre Duke University Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harindra C.","family":"Wijeysundera","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Sunnybrook Health Sciences Centre University of Toronto Canada"},{"name":"Institute of Health Policy Management, and Evaluation University of Toronto Canada"},{"name":"ICES Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.108.123999"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.11.055"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2003.12.009"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2007.06.010"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2007.12.008"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.560433"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2283021254"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2272020617"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415516"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60291-4"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0828-282X(10)70412-8"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015345"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.160823"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001416"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182329778"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2015.07.006"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.07.590"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005462"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.005961"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn018"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487312465525"},{"key":"e_1_3_2_23_2","first-page":"4214","article-title":"Influence of socioeconomic status on acute myocardial infarction in the Chinese population: the INTERHEART China study","volume":"125","author":"Guo J","year":"2012","unstructured":"Guo J, Li W, Wang Y, Chen T, Teo K, Liu LS, Yusuf S. 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