Abstract:
OBJECTIVES:To develop prediction models that better estimate the pretest probability of coronary artery disease in low prevalence populations. DESIGN:Retrospective pooled analysis of individual patient data. SETTING:18 hospitals in Europe and the United States. PARTICIPANTS:Patients with stable chest pain without evidence for previous coronary artery disease, if they were referred for computed tomography (CT) based coronary angiography or catheter based coronary angiography (indicated as low and high prevalence settings, respectively). MAIN OUTCOME MEASURES:Obstructive coronary artery disease (≥ 50% diameter stenosis in at least one vessel found on catheter based coronary angiography). Multiple imputation accounted for missing predictors and outcomes, exploiting strong correlation between the two angiography procedures. Predictive models included a basic model (age, sex, symptoms, and setting), clinical model (basic model factors and diabetes, hypertension, dyslipidaemia, and smoking), and extended model (clinical model factors and use of the CT based coronary calcium score). We assessed discrimination (c statistic), calibration, and continuous net reclassification improvement by cross validation for the four largest low prevalence datasets separately and the smaller remaining low prevalence datasets combined. RESULTS:We included 5677 patients (3283 men, 2394 women), of whom 1634 had obstructive coronary artery disease found on catheter based coronary angiography. All potential predictors were significantly associated with the presence of disease in univariable and multivariable analyses. The clinical model improved the prediction, compared with the basic model (cross validated c statistic improvement from 0.77 to 0.79, net reclassification improvement 35%); the coronary calcium score in the extended model was a major predictor (0.79 to 0.88, 102%). Calibration for low prevalence datasets was satisfactory. CONCLUSIONS:Updated prediction models including age, sex, symptoms, and cardiovascular risk factors allow for accurate estimation of the pretest probability of coronary artery disease in low prevalence populations. Addition of coronary calcium scores to the prediction models improves the estimates.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Genders TS,Steyerberg EW,Hunink MG,Nieman K,Galema TW,Mollet NR,de Feyter PJ,Krestin GP,Alkadhi H,Leschka S,Desbiolles L,Meijs MF,Cramer MJ,Knuuti J,Kajander S,Bogaert J,Goetschalckx K,Cademartiri F,Maffei E,Martinidoi
10.1136/bmj.e3485subject
Has Abstractpub_date
2012-06-12 00:00:00pages
e3485eissn
0959-8138issn
1756-1833journal_volume
344pub_type
杂志文章,meta分析abstract::A study was conducted to investigate a novel approach to the prophylaxis of schizophrenic relapse. The treatment strategy comprised brief intermittent courses of neuroleptic agents begun as soon as non-psychotic symptoms believed to be early signs of relapse appeared. Fifty four stable, remitted outpatients meeting th...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.298.6679.985
更新日期:1989-04-15 00:00:00
abstract:OBJECTIVES:To identify factors that differentiate between effective and ineffective computerised clinical decision support systems in terms of improvements in the process of care or in patient outcomes. DESIGN:Meta-regression analysis of randomised controlled trials. DATA SOURCES:A database of features and effects of...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
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abstract:OBJECTIVE:To determine the outcome of administration of neuroleptics to patients with senile dementia of Lewy body type confirmed at necropsy. DESIGN:Retrospective analysis of clinical notes blind to neuropathological diagnosis. SETTING:Specialist psychogeriatric assessment units referring cases for necropsy to a tea...
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journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.322.7283.400
更新日期:2001-02-17 00:00:00
abstract:OBJECTIVE:To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources. DESIGN:Cluster randomised controlled trial. SETTING:Five healthcare organisations in the United States and 60 affiliated practices. PATIENTS:405 patients, aged ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38219.481250.55
更新日期:2004-09-11 00:00:00
abstract::Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety o...
journal_title:BMJ (Clinical research ed.)
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abstract:OBJECTIVE:To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. DESIGN:Systematic review and meta-analysis of randomised trials, q...
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pub_type: 杂志文章,meta分析,评审
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更新日期:2010-06-11 00:00:00
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更新日期:2000-12-23 00:00:00
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journal_title:BMJ (Clinical research ed.)
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pub_type: 杂志文章,随机对照试验
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更新日期:2010-10-26 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.m1985
更新日期:2020-05-22 00:00:00
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pub_type: 杂志文章
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更新日期:1998-10-31 00:00:00
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doi:10.1136/bmj.h3786
更新日期:2015-07-31 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.315.7102.221
更新日期:1997-07-26 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.321.7271.1265
更新日期:2000-11-18 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2010-10-04 00:00:00
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journal_title:BMJ (Clinical research ed.)
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journal_title:BMJ (Clinical research ed.)
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:2011-10-19 00:00:00
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2005-04-16 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:2014-03-13 00:00:00
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