External validation of novel clinical likelihood models to predict obstructive coronary artery disease and prognosis.

Autor:	Rasmussen LD; Department of Cardiology, Gødstrup Hospital, Herning, Denmark lausra@rm.dk.; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Williams MC; University of Edinburgh, Edinburgh, UK., Newby DE; University of Edinburgh, Edinburgh, UK., Dahl JN; Department of Cardiology, Gødstrup Hospital, Herning, Denmark., Schmidt SE; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark., Bøttcher M; Department of Cardiology, Gødstrup Hospital, Herning, Denmark., Winther S; Department of Cardiology, Gødstrup Hospital, Herning, Denmark.
Jazyk:	angličtina
Zdroj:	Open heart [Open Heart] 2023 Dec 06; Vol. 10 (2). Date of Electronic Publication: 2023 Dec 06.
DOI:	10.1136/openhrt-2023-002457
Abstrakt:	Objectives: The risk factor-weighted and coronary artery calcium score-weighted clinical likelihood (RF-CL and CACS-CL, respectively) models improve discrimination of patients with suspected obstructive coronary artery disease (CAD). However, external validation is warranted.Compared to the 2019 European Society of Cardiology pretest probability (ESC-PTP) model, the aims were (1) to validate the RF-CL and CACS-CL models for identification of obstructive CAD and revascularisation, and (2) to investigate prognosis by CL thresholds. Methods: Stable de novo chest pain patients (n=1585) undergoing coronary CT angiography (CTA) were investigated. Obstructive CAD was defined as >70% diameter stenosis in a major epicardial vessel on CTA. Decision of revascularisation within 120 days was based on onsite judgement. The endpoint was non-fatal myocardial infarction or cardiovascular death. The ESC-PTP was calculated based on age, sex and symptom typicality, the RF-CL additionally included number of risk factors, and the CACS-CL incorporated CACS to the RF-CL. Results: Obstructive CAD was present in 386/1585 (24.4%) patients, and 91/1585 (5.7%) patients underwent revascularisation. Both the RF-CL and CACS-CL classified more patients to very-low CL (<5%) of obstructive CAD compared with the ESC-PTP model (41.4% and 52.2% vs 19.2%, p<0.001). In very-low CL patients, obstructive CAD and revascularisation prevalences (≤6% and <1%) remained similar combined with low event risk during 5.0 years follow-up. Conclusion: In an external validation cohort, the novel RF-CL and CACS-CL models improve categorisation to a very-low CL group with preserved prevalences of obstructive CAD, revascularisation and favourable prognosis. Competing Interests: Competing interests: MB acknowledge support from Acarix in form of an institutional research grant. MB discloses advisory board participation for NOVO Nordisk, Astra-Zeneca, Bayer, Boehringer Ingelheim, Novartis, Sanofi, and Acarix outside of submitted work. MCW has given talks for Canon Medical Systems, Siemens Healthineers and Novartis. DEN is on the Editorial Board and is Deputy Editor of Heart. The remaining authors have nothing to disclose. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu