2024
Symptom assessment and angina classification of patients with ischemia and nonobstructive coronary arteries undergoing invasive coronary function testing: from the DISCOVER INOCA multicenter registry
Shah S, Tremmel J, Henry T, Smilowitz N, Prasad M, Kobayashi Y, Henry G, Samady H, Samuels B, Lerman A, Moses J, Zhang Z, Tirziu D, Chamie D, Lansky A. Symptom assessment and angina classification of patients with ischemia and nonobstructive coronary arteries undergoing invasive coronary function testing: from the DISCOVER INOCA multicenter registry. European Heart Journal 2024, 45: ehae666.1617. DOI: 10.1093/eurheartj/ehae666.1617.Peer-Reviewed Original ResearchCoronary function testingCoronary microvascular dysfunctionInvasive coronary function testingNonobstructive coronary arteriesCanadian Cardiovascular SocietyVasospastic anginaAngina classificationCoronary flow reserveMulticenter registryClassification of patientsChest painCoronary angiographyFemale patientsCMD groupFunction testsAverage coronary flow reserveCoronary arteryPost-procedure diagnosesVasospastic angina groupPatients 4%Coronary vasomotor disordersSymptomatic myocardial bridgingRest symptomsShortness of breathDiagnostic phenotypesDiagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary Function Testing in Women With Angina and Nonobstructive Coronary Arteries.
Cigarroa N, Latif N, Maayah M, Khokhar A, Kunnirickal S, Schwann A, Maciejewski K, Odanovic N, Mazure C, Spatz E, Pfau S, Lansky A, Shah S. Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary Function Testing in Women With Angina and Nonobstructive Coronary Arteries. Journal Of The American Heart Association 2024, 13: e035852. PMID: 39291500, DOI: 10.1161/jaha.124.035852.Peer-Reviewed Original ResearchCoronary function testingNonobstructive coronary arteriesInvasive coronary angiographyCoronary microvascular dysfunctionCoronary angiographyVasomotor disordersFunction testsCoronary arteryAntianginal therapyDiagnostic yieldVasospastic anginaMicrovascular dysfunctionDiagnostic yield of invasive coronary angiographyNonobstructive coronary artery diseaseSuspected ischemic heart diseaseCalcium channel blockersCoronary vasomotor disordersSymptomatic myocardial bridgingCoronary artery diseaseIschemic heart diseaseChannel blockersAnatomic diagnosisEndothelial dysfunctionArtery diseaseMyocardial bridging
2022
Angiographic Lesion Discordance in Women Presenting With Ischemic Heart Disease: Comparison of Visual Assessment, Quantitative Coronary Angiography, and Quantitative Flow Ratio.
Gitto M, Saito Y, Taoutel R, Schneider MD, Papoutsidakis N, Ardito S, Henry G, Cristea E, Lansky AJ, Altin SE. Angiographic Lesion Discordance in Women Presenting With Ischemic Heart Disease: Comparison of Visual Assessment, Quantitative Coronary Angiography, and Quantitative Flow Ratio. Journal Of Invasive Cardiology 2022, 34: e202-e209. PMID: 35089162, DOI: 10.25270/jic/21.00146.Peer-Reviewed Original ResearchConceptsQuantitative coronary angiographyIschemic heart diseaseQuantitative flow ratioStress perfusion imagingDiameter stenosisCoronary angiographyIschemic symptomsCoronary revascularizationHeart diseasePerfusion imagingStenosis severityIndependent core laboratoryCohort of womenVisual assessmentCoronary stenosis severityConsecutive patientsAngiographic severityCoronary stenosisLesion assessmentClinical practiceCore laboratoryLesionsAngiographyWomenBlinded operators
2020
TCT CONNECT-208 Accuracy of Quantitative Coronary Angiography and Visual Assessment for Predicting Functionally Significant Stenoses in Women With Chronic Coronary Syndrome
Gitto M, Taoutel R, Schneider M, Papoutsidakis N, Ardito S, Cristea E, Lansky A, Altin S. TCT CONNECT-208 Accuracy of Quantitative Coronary Angiography and Visual Assessment for Predicting Functionally Significant Stenoses in Women With Chronic Coronary Syndrome. Journal Of The American College Of Cardiology 2020, 76: b88. DOI: 10.1016/j.jacc.2020.09.223.Peer-Reviewed Original ResearchShear Stress Estimated by Quantitative Coronary Angiography Predicts Plaques Prone to Progress and Cause Events
Bourantas CV, Zanchin T, Torii R, Serruys PW, Karagiannis A, Ramasamy A, Safi H, Coskun AU, Koning G, Onuma Y, Zanchin C, Krams R, Mathur A, Baumbach A, Mintz G, Windecker S, Lansky A, Maehara A, Stone PH, Raber L, Stone GW. Shear Stress Estimated by Quantitative Coronary Angiography Predicts Plaques Prone to Progress and Cause Events. JACC Cardiovascular Imaging 2020, 13: 2206-2219. PMID: 32417338, DOI: 10.1016/j.jcmg.2020.02.028.Peer-Reviewed Original ResearchConceptsHigh endothelial shear stressEndothelial shear stressLipid-rich plaquesPlaque burdenCardiovascular eventsPlaque characteristicsMajor adverse cardiovascular eventsSmaller minimum lumen areaLow endothelial shear stressHigh-risk anatomyAdverse cardiovascular eventsUseful prognostic informationQuantitative coronary angiographyMinimum lumen areaPrediction of lesionsLipid-rich lesionsESS valuesCoronary angiographyIndependent predictorsMultivariable analysisHemodynamic variablesPrognostic valueVH-IVUSHemodynamic indicesPrognostic informationPredictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study
Safi H, Bourantas CV, Ramasamy A, Zanchin T, Bär S, Tufaro V, Jin C, Torii R, Karagiannis A, Reiber JHC, Mathur A, Onuma Y, Windecker S, Lansky A, Maehara A, Serruys PW, Stone P, Baumbach A, Stone GW, Räber L. Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study. The International Journal Of Cardiovascular Imaging 2020, 36: 993-1002. PMID: 32152810, DOI: 10.1007/s10554-020-01805-9.Peer-Reviewed Original ResearchMeSH KeywordsAgedCoronary AngiographyCoronary Artery DiseaseCoronary CirculationCoronary VesselsDisease ProgressionFemaleHumansMaleMiddle AgedPlaque, AtheroscleroticPredictive Value of TestsPrognosisRadiographic Image Interpretation, Computer-AssistedRetrospective StudiesRupture, SpontaneousSeverity of Illness IndexTime FactorsUltrasonography, InterventionalConceptsVirtual histology intravascular ultrasoundQuantitative flow ratioMinimum lumen diameterMinimum lumen areaCoronary angiographyPlaque burdenIBIS-4 studyPrognostic informationVulnerable plaquesSmaller minimum lumen areaMajor adverse cardiac eventsVulnerable phenotypeAdverse cardiac eventsGreater plaque burdenPredictors of MACENon-culprit lesionsAdditional prognostic informationSmaller minimum lumen diameterUseful prognostic informationQuantitative coronary angiographyAdditive valueCardiac eventsPlaque characteristicsLesion severityAngiographic dataQUANTITATIVE FLOW RATIO ACCORDING TO THREE-DIMENSIONAL QUANTITATIVE CORONARY ANGIOGRAPHY DEFINED SEVERITY OF STENOSIS IN A COHORT OF WOMEN WITH STABLE CORONARY ARTERY DISEASE
Gitto M, Saito Y, Schneider M, Papoutsidakis N, Ardito S, McCarthy M, Cristea E, Lansky A, Altin S. QUANTITATIVE FLOW RATIO ACCORDING TO THREE-DIMENSIONAL QUANTITATIVE CORONARY ANGIOGRAPHY DEFINED SEVERITY OF STENOSIS IN A COHORT OF WOMEN WITH STABLE CORONARY ARTERY DISEASE. Journal Of The American College Of Cardiology 2020, 75: 177. DOI: 10.1016/s0735-1097(20)30804-4.Peer-Reviewed Original ResearchDISCREPANCY BETWEEN VISUALLY ASSESSED AND QUANTITATIVE CORONARY ANGIOGRAPHY DERIVED DIAMETER STENOSIS IN A COHORT OF WOMEN WITH STABLE CORONARY ARTERY DISEASE
Gitto M, Saito Y, Schneider M, Papoutsidakis N, Ardito S, McCarthy M, Cristea E, Lansky A, Altin S. DISCREPANCY BETWEEN VISUALLY ASSESSED AND QUANTITATIVE CORONARY ANGIOGRAPHY DERIVED DIAMETER STENOSIS IN A COHORT OF WOMEN WITH STABLE CORONARY ARTERY DISEASE. Journal Of The American College Of Cardiology 2020, 75: 178. DOI: 10.1016/s0735-1097(20)30805-6.Peer-Reviewed Original Research
2019
P869Predictive value of the endothelial shear stress distribution in three-dimensional quantitative coronary angiography models in detecting vulnerable plaques
Zanchin T, Bourantas C, Torii R, Serruys P, Karagiannis A, Ramasamy A, Onuma Y, Mathur A, Baumbach A, Windecker S, Lansky A, Maehara A, Stone P, Raeber L, Stone G. P869Predictive value of the endothelial shear stress distribution in three-dimensional quantitative coronary angiography models in detecting vulnerable plaques. European Heart Journal 2019, 40: ehz747.0466. DOI: 10.1093/eurheartj/ehz747.0466.Peer-Reviewed Original ResearchHigh endothelial shear stressEndothelial shear stressLow endothelial shear stressQuantitative coronary angiographyMinimum lumen areaPd/PaVulnerable plaquesPlaque burdenSmaller minimum lumen areaMajor adverse cardiac eventsLarge-scale prospective studiesBaseline plaque characteristicsHigh-risk anatomyAdverse cardiac eventsNon-culprit lesionsOnly independent predictorUseful prognostic informationHigh-risk plaquesESS valuesNC-MACECardiac eventsCoronary atherosclerosisCoronary angiographyIndependent predictorsMultivariable analysis
2018
Comparison of Physician Visual Assessment With Quantitative Coronary Angiography in Assessment of Stenosis Severity in China
Zhang H, Mu L, Hu S, Nallamothu BK, Lansky AJ, Xu B, Bouras G, Cohen DJ, Spertus JA, Masoudi FA, Curtis JP, Gao R, Ge J, Yang Y, Li J, Li X, Zheng X, Li Y, Krumholz HM, Jiang L. Comparison of Physician Visual Assessment With Quantitative Coronary Angiography in Assessment of Stenosis Severity in China. JAMA Internal Medicine 2018, 178: 239-247. PMID: 29340571, PMCID: PMC5838612, DOI: 10.1001/jamainternmed.2017.7821.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overChinaCoronary AngiographyCoronary StenosisCoronary VesselsCross-Sectional StudiesFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedPercutaneous Coronary InterventionPractice Patterns, Physicians'Predictive Value of TestsProspective StudiesRisk AssessmentSeverity of Illness IndexTime FactorsConceptsPhysician visual assessmentPercutaneous coronary interventionAcute myocardial infarctionQuantitative coronary angiographyStenosis severityCoronary angiographyMean agePCI studiesMean percent diameter stenosisIndependent core laboratoryPercent diameter stenosisCross-sectional studyNon-AMI patientsStandard clinical practiceFractional flow reserveSubset of participantsQCA assessmentCoronary revascularizationMore stenosisCoronary interventionCoronary lesionsChina PatientCoronary angiogramDiameter stenosisMyocardial infarction
2016
Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography The International Multicenter FAVOR Pilot Study
Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M, Nef H, Tebaldi M, Murasato Y, Lansky A, Barbato E, van der Heijden LC, Reiber JH, Holm NR, Wijns W, Group F. Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography The International Multicenter FAVOR Pilot Study. JACC Cardiovascular Interventions 2016, 9: 2024-2035. PMID: 27712739, DOI: 10.1016/j.jcin.2016.07.013.Peer-Reviewed Original ResearchMeSH KeywordsAdenosineAdministration, IntravenousAgedArea Under CurveBlood Flow VelocityCardiac CatheterizationChinaComputer SimulationCoronary AngiographyCoronary StenosisCoronary VesselsEuropeFeasibility StudiesFemaleFractional Flow Reserve, MyocardialHumansHyperemiaJapanMaleMiddle AgedModels, CardiovascularMyocardial Perfusion ImagingPilot ProjectsPredictive Value of TestsPrognosisProspective StudiesRadiographic Image Interpretation, Computer-AssistedRegional Blood FlowReproducibility of ResultsROC CurveSeverity of Illness IndexTime FactorsUnited StatesVasodilator AgentsWorkflowConceptsQuantitative flow ratioHyperemic flow velocityReceiver-operating characteristic curveCoronary angiographyDiagnostic accuracyAngiographic percent diameter stenosisDiagnostic coronary angiographyProspective multicenter studyIndependent core laboratoryAdenosine-induced hyperemiaPercent diameter stenosisQuantitative coronary angiographyIntermediate coronary lesionsCharacteristic curveFractional flow reservePositive likelihood ratioOverall diagnostic accuracyNegative likelihood ratioDrug-induced hyperemiaLikelihood ratioCoronary lesionsMulticenter studyDiameter stenosisMaximal hyperemiaFlow reserve
2015
Bioabsorbable polymer‐coated sirolimus‐eluting stent implantation preserves coronary vasomotion: A DESSOLVE II trial sub‐study
Rusinaru D, Vrolix M, Verheye S, Chowdhary S, Schoors D, Di Mario C, Desmet W, Donohoe DJ, Ormiston JA, Knape C, Bezerra H, Lansky A, Wijns W, Investigators O. Bioabsorbable polymer‐coated sirolimus‐eluting stent implantation preserves coronary vasomotion: A DESSOLVE II trial sub‐study. Catheterization And Cardiovascular Interventions 2015, 86: 1141-1150. PMID: 25044635, DOI: 10.1002/ccd.25610.Peer-Reviewed Original ResearchMeSH KeywordsAbsorbable ImplantsAgedCardiac Pacing, ArtificialCardiovascular AgentsCoronary AngiographyCoronary Artery DiseaseCoronary VesselsDrug-Eluting StentsEuropeFemaleHistorically Controlled StudyHumansMaleMiddle AgedNew ZealandPercutaneous Coronary InterventionPolymersProspective StudiesSingle-Blind MethodSirolimusTime FactorsTreatment OutcomeVasoconstrictionVasodilationConceptsZotarolimus-eluting stentsDrug-eluting stentsCoronary vasomotionII trialVasomotor dysfunctionFirst-generation drug-eluting stentsEndeavor zotarolimus-eluting stentsGeneration drug-eluting stentsCoronary vasomotor dysfunctionSirolimus-eluting stentsQuantitative coronary angiographyVessel diameterMaximal pacingCoronary angiographyZES groupCoronary arteryVasomotor responsesHistorical groupStent edgeNormal vasomotionPatientsPercent changeReference segmentsVasomotionSES groupRandomised study of a bioabsorbable polymer-coated sirolimus-eluting stent: results of the DESSOLVE II trial.
Wijns W, Vrolix M, Verheye S, Schoors D, Slagboom T, Gosselink M, Benit E, Donohoe D, Knape C, Attizzani GF, Lansky AJ, Ormiston J. Randomised study of a bioabsorbable polymer-coated sirolimus-eluting stent: results of the DESSOLVE II trial. EuroIntervention 2015, 10: 1383-90. PMID: 24801119, DOI: 10.4244/eijy14m05_03.Peer-Reviewed Original ResearchConceptsZotarolimus-eluting stentsLate lumen lossStent late lumen lossOptical coherence tomographyII trialMajor adverse cardiac eventsMean late lumen lossClinical safety endpointPrimary efficacy hypothesisAdverse cardiac eventsPrimary efficacy endpointStent thrombosis ratesMean neointimal thicknessSirolimus-eluting stentsQuantitative coronary angiographyZES patientsEfficacy endpointPrimary endpointSafety endpointVolume obstructionCardiac eventsCoronary angiographyThrombosis rateZES groupStrut coverage
2013
Response to Letters Regarding Article, “Comparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice
Nallamothu BK, Spertus JA, Lansky AJ, Cohen DJ, Jones PG, Kureshi F, Dehmer GJ, Drozda JP, Walsh MN, Brush JE, Koenig GC, Waites TF, Gantt DS, Kichura G, Chazal RA, O’Brien P, Valentine CM, Rumsfeld JS, Reiber JH, Elmore JG, Krumholz RA, Weaver WD, Krumholz HM. Response to Letters Regarding Article, “Comparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice. Circulation 2013, 128: e463-e464. PMID: 24344070, PMCID: PMC8698215, DOI: 10.1161/circulationaha.113.005507.Peer-Reviewed Original ResearchA composite peripheral blood gene expression score has high sensitivity for obstructive coronary artery disease in a non-invasive imaging population and correlates with plaque burden and morphology by
Voros S, Thomas G, Bateman T, Mcpherson J, Lansky A, Douglas P, Ladapo J, Wingrove J, Elashoff M, Rosenberg S. A composite peripheral blood gene expression score has high sensitivity for obstructive coronary artery disease in a non-invasive imaging population and correlates with plaque burden and morphology by. European Heart Journal 2013, 34: p2413. DOI: 10.1093/eurheartj/eht308.p2413.Peer-Reviewed Original ResearchMyocardial perfusion imagingNon-calcified plaquePlaque burdenInvasive angiogramObstructive coronary artery diseaseQuantitative CTA analysisNon-diabetic patientsCoronary artery diseaseOverall plaque burdenQuantitative coronary angiographyNegative predictive valueGene expression scoreNeutrophil upregulationArtery diseaseCalcium scoreCoronary angiographyInvasive angiographyGES scoresCAD casesBlood samplesCTA analysisPatientsPerfusion imagingReferral pathsPredictive valueSelection and timing for invasive therapy in non-ST-segment-elevation acute coronary syndrome
Meier P, Fröhlich GM, Meller S, De Palma R, Lansky AJ. Selection and timing for invasive therapy in non-ST-segment-elevation acute coronary syndrome. Expert Review Of Cardiovascular Therapy 2013, 11: 437-445. PMID: 23570357, DOI: 10.1586/erc.13.23.Peer-Reviewed Original ResearchConceptsSegment elevation acute coronary syndromesST-segment elevation myocardial infarctionAcute coronary syndromeCoronary syndromeMyocardial infarctionLong-term mortalityBest treatment strategyOptimal time pointNSTEACS patientsTerm mortalityCoronary angiographyOptimal therapyPoor prognosisTreatment strategiesInvasive therapyHigh mortalityOlder agePatientsTime pointsMortalityNSTEACSInfarctionSyndromeTherapyAngiographyComparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice
Nallamothu BK, Spertus JA, Lansky AJ, Cohen DJ, Jones PG, Kureshi F, Dehmer GJ, Drozda JP, Walsh MN, Brush JE, Koenig GC, Waites TF, Gantt DS, Kichura G, Chazal RA, O’Brien P, Valentine CM, Rumsfeld JS, Reiber JH, Elmore JG, Krumholz RA, Weaver WD, Krumholz HM. Comparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice. Circulation 2013, 127: 1793-1800. PMID: 23470859, PMCID: PMC3908681, DOI: 10.1161/circulationaha.113.001952.Peer-Reviewed Original ResearchConceptsQuantitative coronary angiographyPercent diameter stenosisPercutaneous coronary interventionDiameter stenosisCoronary interventionCoronary angiographyCoronary lesionsClinical interpretationAngiographic interpretationStenosis severityHigher percent diameter stenosisMedian percent diameter stenosisElective percutaneous coronary interventionMean differenceCoronary stenosis severityIntermediate lesionsUS hospitalsStenosisLesionsAngiographyPatientsInterventionSeverityVisual assessmentSuch findingsImpact of infarct-related artery patency before primary PCI on outcome in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial.
Rakowski T, Dudek D, Dziewierz A, Yu J, Witzenbichler B, Guagliumi G, Kornowski R, Hartmann F, Lansky AJ, Brener SJ, Mehran R, Stone GW. Impact of infarct-related artery patency before primary PCI on outcome in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. EuroIntervention 2013, 8: 1307-14. PMID: 23538158, DOI: 10.4244/eijv8i11a199.Peer-Reviewed Original ResearchMeSH KeywordsAgedChi-Square DistributionCoronary AngiographyCoronary CirculationCoronary StenosisCoronary VesselsElectrocardiographyFemaleHumansKaplan-Meier EstimateMaleMiddle AgedMultivariate AnalysisMyocardial InfarctionPercutaneous Coronary InterventionPredictive Value of TestsProportional Hazards ModelsProspective StudiesRisk AssessmentRisk FactorsThrombosisTime FactorsTreatment OutcomeVascular PatencyConceptsEarly IRA patencyPrimary percutaneous coronary interventionPercutaneous coronary interventionHORIZONS-AMI trialOne-year mortalityIRA patencyIndependent predictorsST-segment elevation myocardial infarctionMyocardial blush grade 2Infarct-related artery patencyBaseline coronary angiographyBetter TIMI flowMyocardial Infarction 2Probable stent thrombosisTIMI 3 flowOne-year outcomesOutcomes of patientsElevation myocardial infarctionGood angiographic resultBaseline angiographyTIMI 0TIMI flowArtery patencyCoronary interventionCoronary angiographyA Blood-Based Gene Expression Test for Obstructive Coronary Artery Disease Tested in Symptomatic Nondiabetic Patients Referred for Myocardial Perfusion Imaging The COMPASS Study
Thomas GS, Voros S, McPherson JA, Lansky AJ, Winn ME, Bateman TM, Elashoff MR, Lieu HD, Johnson AM, Daniels SE, Ladapo JA, Phelps CE, Douglas PS, Rosenberg S. A Blood-Based Gene Expression Test for Obstructive Coronary Artery Disease Tested in Symptomatic Nondiabetic Patients Referred for Myocardial Perfusion Imaging The COMPASS Study. Circulation Genomic And Precision Medicine 2013, 6: 154-162. PMID: 23418288, DOI: 10.1161/circgenetics.112.964015.Peer-Reviewed Original ResearchConceptsMyocardial perfusion imagingInvasive coronary angiographyGene expression scoreCoronary angiographyNegative predictive valueNondiabetic patientsSymptomatic patientsClinical factorsPredictive valuePrespecified primary end pointObstructive coronary artery diseaseAbnormal myocardial perfusion imagingBlood-based gene expression testAdverse cardiovascular eventsPrimary end pointCoronary artery diseaseReceiver-operating characteristic curvePeripheral blood samplesReceiver-operating characteristic analysisCoronary artery disease diagnosisMaximum percent stenosisGene expression testReceiver-operating characteristicCardiovascular eventsArtery disease
2012
A gender-specific blood-based gene expression score for assessing obstructive coronary artery disease in nondiabetic patients: Results of the Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) Trial
Lansky A, Elashoff MR, Ng V, McPherson J, Lazar D, Kraus WE, Voros S, Schwartz RS, Topol EJ. A gender-specific blood-based gene expression score for assessing obstructive coronary artery disease in nondiabetic patients: Results of the Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) Trial. American Heart Journal 2012, 164: 320-326. PMID: 22980297, DOI: 10.1016/j.ahj.2012.05.012.Peer-Reviewed Original ResearchConceptsObstructive coronary artery diseaseCoronary artery diseaseMyocardial perfusion imagingGene expression scoreQuantitative coronary angiographyExpression scoreNondiabetic patientsArtery diseaseCardiac catheterizationCoronary angiographyBurden of CADSeverity of CADNoninvasive myocardial perfusion imagingProspective multicenter observational studyUnknown coronary artery diseaseSignificant coronary artery diseaseDiagnostic approachUnnecessary cardiac catheterizationMulticenter observational studyChest pain symptomsDiagnostic cardiac catheterizationAvailable noninvasive testsNoninvasive test resultsPositive predictive valueReliable diagnostic approach