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Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study
S. Feger, P. Ibes, AE. Napp, A. Lembcke, M. Laule, H. Dreger, B. Bokelmann, GK. Davis, G. Roditi, I. Diez, S. Schröder, F. Plank, P. Maurovich-Horvat, R. Vidakovic, J. Veselka, M. Ilnicka-Suckiel, A. Erglis, T. Benedek, J. Rodriguez-Palomares, L....
Language English Country Germany
Document type Clinical Trial, Journal Article
Grant support
EC-GA 603266
FP7 Ideas: European Research Council
NLK
CINAHL Plus with Full Text (EBSCOhost)
from 2008-01-01 to 1 year ago
Medline Complete (EBSCOhost)
from 2000-01-01 to 1 year ago
- MeSH
- Computed Tomography Angiography MeSH
- Risk Assessment MeSH
- Coronary Angiography MeSH
- Coronary Stenosis * diagnostic imaging epidemiology MeSH
- Humans MeSH
- Coronary Artery Disease * diagnostic imaging epidemiology MeSH
- Pilot Projects MeSH
- Predictive Value of Tests MeSH
- Patient Discharge MeSH
- Risk Factors MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Geographicals
- Europe MeSH
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.
Berlin School of Public Health Berlin Berlin Germany
Centro de Investigación Biomédica en Red CV CIBER CV Barcelona Spain
Charité Universitätsmedizin Berlin Department of Radiology Berlin Institute of Health Berlin Germany
Department of Cardiology Aintree University Hospital Liverpool UK
Department of Cardiology ALB FILS KLINIKEN Goeppingen Germany
Department of Cardiology and Radiology Rigshospitalet University of Copenhagen Copenhagen Denmark
Department of Cardiology Basurto University Hospital Bilbao Bilbao Spain
Department of Cardiology Cardio Med Medical Center Targu Mures Târgu Mureș Romania
Department of Cardiology Centro Hospitalar de Vila Nova de Gaia Vila Nova de Gaia Portugal
Department of Cardiology Lithuanian University of Health Sciences Kaunas Lithuania
Department of Cardiology Southeastern Health and Social Care Trust Belfast Ireland
Department of Cardiology Wojewodzki Szpital Specjalistyczny We Wroclawiu Wrocław Poland
Department of Radiology and Department of Cardiology Medical University Innsbruck Innsbruck Austria
Department of Radiology Azienda Ospedaliero Universitaria di Cagliari Cagliari Italy
Department of Radiology Medical Imaging Centre Semmelweis University Budapest Hungary
Dept of Coronary and Structural Heart Diseases Institute of Cardiology Warsaw Poland
DZHK partner site Berlin Germany
Institute of Cardiovascular and Medical Sciences Glasgow University Glasgow UK
Latvian Centre of Cardiology Pauls Stradins Clinical University Hospital Riga Latvia
Royal Liverpool and Broadgreen University Hospital Liverpool UK
Turku PET Centre and Heart Centre Turku University Hospital Turku Finland
References provided by Crossref.org
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