TY - JOUR
T1 - Clinical pre-test probability for obstructive coronary artery disease
T2 - insights from the European DISCHARGE pilot study
AU - Feger, Sarah
AU - Ibes, Paolo
AU - Napp, Adriane E.
AU - Lembcke, Alexander
AU - Laule, Michael
AU - Dreger, Henryk
AU - Bokelmann, Björn
AU - Davis, Gershan K.
AU - Roditi, Giles
AU - Diez, Ignacio
AU - Schröder, Stephen
AU - Plank, Fabian
AU - Maurovich-Horvat, Pal
AU - Vidakovic, Radosav
AU - Veselka, Josef
AU - Ilnicka-Suckiel, Malgorzata
AU - Erglis, Andrejs
AU - Benedek, Teodora
AU - Rodriguez-Palomares, José
AU - Saba, Luca
AU - Kofoed, Klaus F.
AU - Gutberlet, Matthias
AU - Ađić, Filip
AU - Pietilä, Mikko
AU - Faria, Rita
AU - Vaitiekiene, Audrone
AU - Dodd, Jonathan D.
AU - Donnelly, Patrick
AU - Francone, Marco
AU - Kepka, Cezary
AU - Ruzsics, Balazs
AU - Müller-Nordhorn, Jacqueline
AU - Schlattmann, Peter
AU - Dewey, Marc
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/9/9
Y1 - 2020/9/9
N2 - 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%), 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). 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/NCT02400229 Key Points: • 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.
AB - 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%), 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). 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/NCT02400229 Key Points: • 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.
KW - Computed tomography angiography
KW - Coronary artery disease
KW - Prevalence
KW - Probability of disease
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U2 - 10.1007/s00330-020-07175-z
DO - 10.1007/s00330-020-07175-z
M3 - Article (journal)
C2 - 32902743
AN - SCOPUS:85090461170
SN - 0938-7994
VL - 31
SP - 1471
EP - 1481
JO - European Radiology
JF - European Radiology
IS - 3
ER -