A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension
| Autor: | Jeroen J. Bax, Lotus Desbiolles, Nico R. Mollet, Michael Laule, Guy Friedrich, Tessa S. S. Genders, Kaatje Goetschalckx, Erica Maffei, Juhani Knuuti, Elke Zimmermann, Hatem Alkadhi, Valentin Sinitsyn, Jan Bogaert, Gudrun Feuchtner, Tjebbe W. Galema, Matthijs F.L. Meijs, Rossella Barbagallo, Fleur R. de Graaf, Carlos Van Mieghem, Sebastian Leschka, Joanne D. Schuijf, Marc Dewey, Maarten J Cramer, Gabriel P. Krestin, Pim J. de Feyter, Garrett W. Rowe, Deepa Gopalan, M. G. Myriam Hunink, Ewout W. Steyerberg, W. Bob Meijboom, U. Joseph Schoepf, Sami Kajander, Filippo Cademartiri, Francesca Pugliese, Koen Nieman |
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| Přispěvatelé: | University of Zurich, Radiology & Nuclear Medicine, Public Health, Cardiology |
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Angina pectoris 610 Medicine & health Clinical prediction rule 030204 cardiovascular system & hematology Chest pain Logistic regression Risk Assessment Coronary artery disease 2705 Cardiology and Cardiovascular Medicine Decision Support Techniques Angina 03 medical and health sciences Pre-test probability 0302 clinical medicine Predictive Value of Tests Prediction model Internal medicine Validation medicine Humans Angina Stable Prospective Studies 030212 general & internal medicine Aged Probability Aged 80 and over Receiver operating characteristic business.industry 10042 Clinic for Diagnostic and Interventional Radiology Coronary Stenosis Stable chest pain Middle Aged medicine.disease 3. Good health Pre- and post-test probability Early Diagnosis ROC Curve Predictive value of tests Calibration Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal, 32(11), 1316-1330 European Heart Journal, 32(11), 1316-1330. Oxford University Press |
| ISSN: | 0195-668X |
| DOI: | 10.5167/uzh-47441 |
| Popis: | Aims The aim was to validate, update, and extend the Diamond-Forrester model for estimating the probability of obstructive coronary artery disease (CAD) in a contemporary cohort. Methods and results Prospectively collected data from 14 hospitals on patients with chest pain without a history of CAD and referred for conventional coronary angiography (CCA) were used. Primary outcome was obstructive CAD, defined as ≥50% stenosis in one or more vessels on CCA. The validity of the Diamond-Forrester model was assessed using calibration plots, calibration-in-the-large, and recalibration in logistic regression. The model was subsequently updated and extended by revising the predictive value of age, sex, and type of chest pain. Diagnostic performance was assessed by calculating the area under the receiver operating characteristic curve (c-statistic) and reclassification was determined. We included 2260 patients, of whom 1319 had obstructive CAD on CCA. Validation demonstrated an overestimation of the CAD probability, especially in women. The updated and extended models demonstrated a c-statistic of 0.79 (95% CI 0.77-0.81) and 0.82 (95% CI 0.80-0.84), respectively. Sixteen per cent of men and 64% of women were correctly reclassified. The predicted probability of obstructive CAD ranged from 10% for 50-year-old females with non-specific chest pain to 91% for 80-year-old males with typical chest pain. Predictions varied across hospitals due to differences in disease prevalence. Conclusion Our results suggest that the Diamond-Forrester model overestimates the probability of CAD especially in women. We updated the predictive effects of age, sex, type of chest pain, and hospital setting which improved model performance and we extended it to include patients of 70 years and older |
| Databáze: | OpenAIRE |
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