Clinical pre-test probability for obstructive coronary artery disease : insights from the European DISCHARGE pilot study
Feger, Sarah (Humboldt-Universität zu Berlin)
Ibes, Paolo (Humboldt-Universität zu Berlin)
Napp, Adriane E. (Humboldt-Universität zu Berlin)
Lembcke, Alexander (Humboldt-Universität zu Berlin)
Laule, Michael (Humboldt-Universität zu Berlin)
Dreger, Henryk (Humboldt-Universität zu Berlin)
Bokelmann, Björn (Humboldt-Universität zu Berlin)
Davis, Gershan (University of Central Lancashire)
Roditi, Giles (Glasgow University. Institute of Cardiovascular and Medical Sciences)
Diez, Ignacio (Hospital de Basurto (Bilbao, Biscaia))
Schröder, Stephen (ALB FILS KLINIKEN. Department of Cardiology)
Plank, Fabian (Medical University Innsbruck. Department of Radiology and Department of Cardiology)
Maurovich-Horvat, Pal (Semmelweis University. Department of Radiology, Medical Imaging Centre)
Vidakovic, Radosav (University of Belgrade. Department of Cardiology, Clinical Hospital Center "Zemun", Faculty of Medicine)
Veselka, Josef (Charles University. Faculty of Medicine in Hradec Králové)
Ilnicka-Suckiel, Malgorzata (Wojewodzki Szpital Specjalistyczny We Wroclawiu. Department of Cardiology)
Erglis, Andrejs (Pauls Stradins Clinical University Hospital. Latvian Centre of Cardiology)
Benedek, Theodora (Department of Cardiology, Cardio Med Medical Center Targu-Mures, Târgu Mureș)
Rodriguez-Palomares, José (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Saba, Luca (Azienda Ospedaliero Universitaria di Cagliari. Department of Radiology)
Kofoed, Klaus F. (University of Copenhagen)
Gutberlet, Matthias (UNIVERSITY LEIPZIG -Heart Center Leipzig. Department of Diagnostic and Interventional Radiology)
Ađić, Filip (University of Novi Sad. Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Faculty of Medicine)
Pietilä, Mikko (Turku University Hospital. Turku PET Centre and Heart Centre)
Faria, Rita (Centro Hospitalar de Vila Nova de Gaia. Department of Cardiology)
Vaitiekiene, Audrone (Lithuanian University of Health Sciences. Department of Cardiology)
Dodd, Jonathan D. (University College Dublin. Department of Radiology, St. Vincent's University hospital, School of Medicine)
Donnelly, Patrick (Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, Ireland)
Francone, Marco (Sapienza University of Rome. Department of Radiological, Pathological and Oncological Sciences)
Kepka, Cezary (Institute of Cardiology. Dept. of Coronary and Structural Heart Diseases)
Ruzsics, Balazs (Royal Liverpool and Broadgreen University Hospital)
Müller-Nordhorn, Jacqueline (Berlin School of Public Health Berlin)
Schlattmann, Peter (Institut für Statistik, Medizinische Informatik, Datenwissenschaften Universitätsklinikum Jena, Leipzig, Germany)
Dewey, Marc (DZHK (German Centre for Cardiovascular Research))
Universitat Autònoma de Barcelona

Fecha:	2020
Resumen:	To test the accuracy of clinical pre-test probability (PTP) for prediction of obstructive coronary artery disease (CAD) in a pan-European setting. 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. 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%), both p < 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). 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. • Clinical 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. The online version of this article (10. 1007/s00330-020-07175-z) contains supplementary material, which is available to authorized users.
Ayudas:	European Commission 603266
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Coronary artery disease ; Computed tomography angiography ; Probability of disease ; Prevalence
Publicado en:	European Radiology, Vol. 31 (september 2020) , p. 1471-1481, ISSN 1432-1084

DOI: 10.1007/s00330-020-07175-z
PMID: 32902743

11 p, 700.7 KB

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