European Society of Cardiology-Recommended Coronary Artery Disease Consortium Pretest Probability Scores More Accurately Predict Obstructive Coronary Disease and Cardiovascular Events Than the Diamond and Forrester Score: The Partners Registry
| Autor: | Ron Blankstein, Tamar S. Polonsky, Edward Hulten, Khurram Nasir, Suhny Abbara, Udo Hoffman, Márcio Sommer Bittencourt, Marcelo F. Di Carli |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
medicine.medical_specialty Cardiology Coronary Disease 030204 cardiovascular system & hematology Coronary disease Chest pain Risk Assessment Severity of Illness Index Coronary artery disease 03 medical and health sciences 0302 clinical medicine Physiology (medical) Internal medicine medicine Humans 030212 general & internal medicine Registries Societies Medical Aged business.industry Middle Aged medicine.disease Pre- and post-test probability Treatment Outcome ROC Curve Area Under Curve Heart Function Tests medicine.symptom Cardiology and Cardiovascular Medicine Risk assessment business Tomography Spiral Computed |
| Zdroj: | Circulation. 134(3) |
| ISSN: | 1524-4539 |
| Popis: | Background: The most appropriate score for evaluating the pretest probability of obstructive coronary artery disease (CAD) is unknown. We sought to compare the Diamond-Forrester (DF) score with the 2 CAD consortium scores recently recommended by the European Society of Cardiology. Methods: We included 2274 consecutive patients (age, 56±13 years; 57% male) without prior CAD referred for coronary computed tomographic angiography. Computed tomographic angiography findings were used to determine the presence or absence of obstructive CAD (≥50% stenosis). We compared the DF score with the 2 CAD consortium scores with respect to their ability to predict obstructive CAD and the potential implications of these scores on the downstream use of testing for CAD, as recommended by current guidelines. Results: The DF score did not satisfactorily fit the data and resulted in a significant overestimation of the prevalence of obstructive CAD ( P P =0.39). The DF score had a lower discrimination for obstructive CAD, with an area under the receiver-operating characteristics curve of 0.713 versus 0.752 and 0.791 for the CAD consortium models ( P P P Conclusions: Among contemporary patients referred for noninvasive testing, the DF risk score overestimates the risk of obstructive CAD. On the other hand, the CAD consortium scores offered improved goodness of fit and discrimination; thus, their use could decrease the need for noninvasive or invasive testing while increasing the yield of such tests. |
| Databáze: | OpenAIRE |
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