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Incorporating Coronary Calcification Into Pre-Test Assessment of the Likelihood of Coronary Artery Disease.

Abstract：

BACKGROUND:The prevalence of obstructive coronary artery disease (CAD) in symptomatic patients referred for diagnostic testing has declined, warranting optimization of individualized diagnostic strategies. OBJECTIVES:This study sought to present a simple, clinically applicable tool enabling estimation of the likelihood of obstructive CAD by combining a pre-test probability (PTP) model (Diamond-Forrester approach using sex, age, and symptoms) with clinical risk factors and coronary artery calcium score (CACS). METHODS:The new tool was developed in a cohort of symptomatic patients (n = 41,177) referred for diagnostic testing. The risk factor-weighted clinical likelihood (RF-CL) was calculated through PTP and risk factors, while the CACS-weighted clinical likelihood (CACS-CL) added CACS. The 2 calculation models were validated in European and North American cohorts (n = 15,411) and compared with a recently updated PTP table. RESULTS:The RF-CL and CACS-CL models predicted the prevalence of obstructive CAD more accurately in the validation cohorts than the PTP model, and markedly increased the area under the receiver-operating characteristic curves of obstructive CAD: for the PTP model, 72 (95% confidence intervals [CI]: 71 to 74); for the RF-CL model, 75 (95% CI: 74 to 76); and for the CACS-CL model, 85 (95% CI: 84 to 86). In total, 38% of the patients in the RF-CL group and 54% in the CACS-CL group were categorized as having a low clinical likelihood of CAD, as compared with 11% with the PTP model. CONCLUSIONS:A simple risk factor and CACS-CL tool enables improved prediction and discrimination of patients with suspected obstructive CAD. The tool empowers reclassification of patients to low likelihood of CAD, who need no further testing.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Winther S,Schmidt SE,Mayrhofer T,Bøtker HE,Hoffmann U,Douglas PS,Wijns W,Bax J,Nissen L,Lynggaard V,Christiansen JJ,Saraste A,Bøttcher M,Knuuti J

doi

10.1016/j.jacc.2020.09.585

subject

Has Abstract

pub_date

2020-11-24 00:00:00

pages

2421-2432

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(20)37367-8

journal_volume

pub_type

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Incorporating Coronary Calcification Into Pre-Test Assessment of the Likelihood of Coronary Artery Disease.