Observer reproducibility and validity of systems for clinical classification of angina pectoris: comparison with radionuclide imaging and coronary angiography

Summary Objective:  To assess reproducibility and validity of clinical classification of angina pectoris (AP) patients. Design:  Fifty‐six patients scheduled for coronary angiography because of stable AP were classified by two independent observers with regard to (i) type and (ii) severity of chest...

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Bibliographic Details
Published in:Clinical physiology and functional imaging 2006-01, Vol.26 (1), p.26-31
Main Authors: Christensen, Henrik Wulff, Haghfelt, Torben, Vach, Werner, Johansen, Allan, Høilund-Carlsen, Poul Flemming
Format: Article
Language:English
Subjects:
Adult
Aged
Angina Pectoris - classification
Angina Pectoris - diagnosis
Angina Pectoris - epidemiology
angiography
Biological and medical sciences
Cardiology. Vascular system
chest pain
classification systems
Coronary Angiography
Coronary heart disease
Female
Heart
Humans
Male
Medical sciences
Middle Aged
observer agreement
Observer Variation
Physical Examination
Prospective Studies
Radiopharmaceuticals
Reproducibility of Results
scintigraphy
Severity of Illness Index
Technetium Tc 99m Sestamibi
Thallium Radioisotopes
Tomography, Emission-Computed, Single-Photon
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Summary:Summary Objective:  To assess reproducibility and validity of clinical classification of angina pectoris (AP) patients. Design:  Fifty‐six patients scheduled for coronary angiography because of stable AP were classified by two independent observers with regard to (i) type and (ii) severity of chest pain (Canadian Cardiovascular Society, CCS) and (iii) cardiac functional status (New York Heart Association, NYHA). Myocardial perfusion imaging (MPI) was performed in 55 including measurement of ejection fraction in 46, angiography was undertaken in 51. Results:  Observers agreed 100% on the presence (n = 45) or absence (n = 11) of angina. They agreed in 52 (93%), 48 (86%), and 42 (75%) patients with regard to type of pain, CCS grade, and NYHA class, respectively. In the remaining patients, they disagreed by one class only. The positive and negative predictive values of typical/atypical angina for perfusion abnormalities and coronary disease were 55%/82% and 53%/82%, respectively. Conclusions:  Observer agreement was excellent for presence, type, and severity of chest pain but moderate with regard NYHA class. Clinical judgment could not predict with reasonable accuracy abnormal perfusion or coronary artery disease.
ISSN:1475-0961
1475-097X
DOI:10.1111/j.1475-097X.2005.00643.x