Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study
Radosav Vidakovic; Pal Maurovich-Horvat; Jacqueline Müller-Nordhorn; Malgorzata Ilnicka-Suckiel; Klaus F. Kofoed; Balazs Ruzsics; Fabian Plank; Andrejs Erglis; Mikko Pietilä; Henryk Dreger; Adriane E. Napp; Stephen Schröder; Matthias Gutberlet; Paolo Ibes; Gershan K. Davis; Alexander Lembcke; Jonathan D. Dodd; Teodora Benedek; Sarah Feger; Audrone Vaitiekiene; Filip Ađić; Patrick Donnelly; Marco Francone; Rita Faria; Marc Dewey; Michael Laule; Ignacio Diez; José Rodriguez-Palomares; Peter Schlattmann; Luca Saba; Cezary Kepka; Josef Veselka; Björn Bokelmann; Giles Roditi
Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study
Radosav Vidakovic
Pal Maurovich-Horvat
Jacqueline Müller-Nordhorn
Malgorzata Ilnicka-Suckiel
Klaus F. Kofoed
Balazs Ruzsics
Fabian Plank
Andrejs Erglis
Mikko Pietilä
Henryk Dreger
Adriane E. Napp
Stephen Schröder
Matthias Gutberlet
Paolo Ibes
Gershan K. Davis
Alexander Lembcke
Jonathan D. Dodd
Teodora Benedek
Sarah Feger
Audrone Vaitiekiene
Filip Ađić
Patrick Donnelly
Marco Francone
Rita Faria
Marc Dewey
Michael Laule
Ignacio Diez
José Rodriguez-Palomares
Peter Schlattmann
Luca Saba
Cezary Kepka
Josef Veselka
Björn Bokelmann
Giles Roditi
SPRINGER
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2021042821213
https://urn.fi/URN:NBN:fi-fe2021042821213
Tiivistelmä
Objectives To test the accuracy of clinical pre-test probability (PTP) for prediction of obstructive coronary artery disease (CAD) in a pan-European setting.Methods Patients with suspected CAD and stable chest pain who were clinically referred for invasive coronary angiography (ICA) or computed tomography (CT) were included by clinical sites participating in the pilot study of the European multi-centre DISCHARGE trial. PTP of CAD was determined using the Diamond-Forrester (D+F) prediction model initially introduced in 1979 and the updated D+F model from 2011. Obstructive coronary artery disease (CAD) was defined by one at least 50% diameter coronary stenosis by both CT and ICA.Results In total, 1440 patients (654 female, 786 male) were included at 25 clinical sites from May 2014 until July 2017. Of these patients, 725 underwent CT, while 715 underwent ICA. Both prediction models overestimated the prevalence of obstructive CAD (31.7%, 456 of 1440 patients, PTP: initial D+F 58.9% (28.1-90.6%), updated D+F 47.3% (34.2-59.9%), bothp< 0.001), but overestimation of disease prevalence was higher for the initial D+F (p< 0.001). The discriminative ability was higher for the updated D+F 2011 (AUC of 0.73 95% confidence interval [CI] 0.70-0.76 versus AUC of 0.70 CI 0.67-0.73 for the initial D+F;p< 0.001; odds ratio (or) 1.55 CI 1.29-1.86, net reclassification index 0.11 CI 0.05-0.16,p< 0.001).Conclusions Clinical PTP calculation using the initial and updated D+F prediction models relevantly overestimates the actual prevalence of obstructive CAD in patients with stable chest pain clinically referred for ICA and CT suggesting that further refinements to improve clinical decision-making are needed.Trial registration https://www.clinicaltrials.gov/ct2/show/NCT02400229Key PointsClinical pre-test probability calculation using the initial and updated D+F model overestimates the prevalence of obstructive CAD identified by ICA and CT.Overestimation of disease prevalence is higher for the initial D+F compared with the updated D+F.Diagnostic accuracy of PTP assessment varies strongly between different clinical sites throughout Europe.
Kokoelmat
- Rinnakkaistallenteet [19207]