MI but a Clean Cath?
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Da Costa et al. “Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary
angiogram: A 3-year follow-up study of 91 patients.” European Heart Journal 2001; 22: 1459-65.
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• Gold standards can be misleading
• Use all tests help you refine your clinical decision-making from pre-test to post-test
• “Clean cath” is not a valid Pubmed search term
The Gold Standard
- Angiography: gold standard for noninvasive tests for CAD
o Limits: can underestimate disease severity, interobserver variability, comparisons with
diseased reference diameters in other vessels
o Quantitative angiography: greater predictive physiologic significance
- Posttest referral bias
o True-positive or false-positive noninvasive test results (not true negative) -> angiography
o Normalcy rate as surrogate for specificity: % of normal scans in patients who have <5%
posttest likelihood of CAD with pre-cath data (should be considered with all new tests)
- New tests: highly selected patient populations (normal volunteers or severely diseased patients) -
> higher sensitivities and specificities for any new tests
Elevated troponin or myocardial infaction with angiographically normal coronary arteries
- Prevalence: 3% among thos