Standard clinical and stress electrocardiogram variables to exclude left main and left main-equivalent disease: the MASTER study
Authors' conclusion
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.
Study context
- Population
- Patients with chronic coronary syndrome undergoing invasive coronary angiography after a maximal ECG stress test
- Participants
- 335 vs 797
- Comparison
- Cases vs Controls
- Casesn = 335
- Controlsn = 797reference
- Outcome
- Diagnostic utility of a clinical and ECG stress testing (EST) variable model in excluding LMCAD/LMCAD-equivalent
Methodological detailsmulticentre, 1:3 matched, internal and external validation
- Multicentre
- 1:3 matched
- Internal and external validation
Main finding
As reported in the abstract
Exclusion of LMCAD/LMCAD-equivalent by the clinical + EST risk model
Model AUC
.78
NPV (assumed LMCAD prevalence 5%, misclassification cost ratio 1:100)
98.2%
Coronary angiography (CAG) safely avoided
41%
CAGs safely spared per missed LMCAD/LMCAD-equivalent diagnosis
58
Observational data: associations, not effects.
Original publication
Standard clinical and stress electrocardiogram variables to exclude left main and left main-equivalent disease: the MASTER study. Eur Heart J. Published 23 July 2026. doi:10.
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