Non-invasive imaging and exercise stress tests have limited ability to predict left main coronary artery stenosis of 50% or more in patients with moderate-to-severe ischaemia, a comprehensive analysis shows.

Instead, clinicians may need to rely on anatomical imaging to rule out left main coronary artery (LMCA) disease in this setting, according to international researchers, including Adelaide cardiac imaging specialist Professor Joseph Selvanayagam from Flinders University.

In a post-hoc analysis of the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, the team used clinical and stress testing parameters to identify markers of LMCA disease via coronary CT angiography.

They drew upon data from more than 5100 participants (mean age 63; 74% male) with locally determined moderate or severe ischaemia, 8% of whom had positive findings of over 50% LMCA disease.