Standard clinical and stress electrocardiogram variables to exclude left main and left main-equivalent disease: the MASTER study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: A simple diagnostic method able to reliably exclude left main (LM) coronary artery disease (CAD) or LMCAD-equivalent would expand implementation of an initial non-invasive strategy in patients with chronic coronary syndrome (CCS). This study assessed the diagnostic utility of an approach using clinical and ECG stress testing (EST) variables in excluding LMCAD/LMCAD-equivalent in CCS patients. METHODS: In a multicentre case-control study, CCS patients undergoing invasive coronary angiography (CAG) after a maximal EST were evaluated. Cases were patients with angiographic ≥ 50% LM stenosis or ≥70% stenosis of both proximal left anterior descending and proximal circumflex arteries, matched with similar patients without them (controls) in a 1:3 ratio. A risk model developed through logistic regression was internally and externally validated. RESULTS: Three hundred and thirty-five cases were matched with 797 controls. The model area under the curve (AUC) was .78. Assuming LMCAD prevalence of 5% and a misclassification cost ratio of 1:100 (ratio of cost of performing CAG in a control to cost of not performing CAG in a case), negative predictive value was 98.2%. Thus, CAG could be safely avoided in 41% of patients, missing one LMCAD/LMCAD-equivalent diagnosis for every 58 CAGs safely spared in patients without them. CONCLUSIONS: Among CCS patients, LMCAD/LMCAD-equivalent can be excluded with high negative predictive value through a model based on clinical and EST parameters, allowing initial non-invasive management of most patients able to exercise. This approach is potentially useful particularly in communities where access to computed tomography coronary angiography is limited.
Source: European Heart Journal
Authors: Marco De Carlo, Marco Andrea Malanima, Laura Baglietto, Lorenzo Bazan, Sergio Berti, Paolo Calabrò, Luca Carmisciano, Alberto Ranieri De Caterina, Simona Fabozzo, Marco Fornili, Andrea Ghisletti, Elias Hellou, Gaetano Antonio Lanza, Nastasia Mancini, Cristiano Massacesi, Danilo Neglia, Maria Concetta Pastore, Giuseppe Patti, Saverio Tremamunno, Giampiero Vizzari, William S Weintraub, Amir Lerman, Pier Luigi Temporelli, Raffaele De Caterina
Institutions: Azienda Ospedaliera Universitaria Pisana, University of Pisa, Fondazione Toscana Gabriele Monasterio, University of Campania "Luigi Vanvitelli", Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, Azienda Ospedaliero Universitaria Maggiore della Carita, Mayo Clinic, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, University of Messina, ASL Lanciano Vasto Chieti, University of Siena, MedStar Health Research Institute, Istituti Clinici Scientifici Maugeri
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,922
OpenAlex ID: W7170190922