Robert Roehle1, Viktoria Wieske1, Georg M Schuetz1, Pascal Gueret2, Daniele Andreini3,4, Willem Bob Meijboom5, Gianluca Pontone3, Mario Garcia6, Hatem Alkadhi7, Lily Honoris8, Jörg Hausleiter9, Nuno Bettencourt10, Elke Zimmermann1, Sebastian Leschka11, Bernhard Gerber12, Carlos Rochitte13, U Joseph Schoepf14, Abbas Arjmand Shabestari15, Bjarne Nørgaard16, Akira Sato17, Juhani Knuuti18, Matthijs F L Meijs19, Harald Brodoefel20, Shona M M Jenkins21, Kristian Altern Øvrehus22,23, Axel Cosmus Pyndt Diederichsen22, Ashraf Hamdan24,25, Bjørn Arild Halvorsen26, Vladimir Mendoza Rodriguez27, Yung Liang Wan28,29, Johannes Rixe30, Mehraj Sheikh31,32, Christoph Langer33,34, Said Ghostine35, Eugenio Martuscelli36, Hiroyuki Niinuma37, Arthur Scholte38, Konstantin Nikolaou39, Geir Ulimoen40, Zhaoqi Zhang41, Hans Mickley22, Koen Nieman42,43, Philipp A Kaufmann44, Ronny Ralf Buechel44, Bernhard A Herzog44, Melvin Clouse45, David A Halon46,47, Jonathan Leipsic48, David Bush49,50, Reda Jakamy51, Kai Sun52, Lin Yang41, Thorsten Johnson53, Jean-Pierre Laissy54, Roy Marcus55, Simone Muraglia56, Jean-Claude Tardif57, Benjamin Chow58, Narinder Paul59,60, David Maintz61, John Hoe62, Albert de Roos63, Robert Haase1, Michael Laule64, Peter Schlattmann65, Marc Dewey66. 1. Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany. 2. Cardiology Department, Henri Mondor Hospital, University Paris Est Creteil, Créteil, France. 3. Centro Cardiologico Monzino, IRCCS, Milan, Italy. 4. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy. 5. IJsselland Ziekenhuis, Capelle a/d IJssel, The Netherlands. 6. Montefiore, the University Hospital for the Albert Einstein College of Medicine, New York City, NY, USA. 7. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland. 8. Aurora Health Care, Milwaukee, WI, USA. 9. Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University of Munich, Munich, Germany. 10. Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal. 11. Department of Radiology and Nuclear Medicine Kantonsspital St. Gallen, St. Gallen, Switzerland. 12. Division of Cardiology, Cardiovascular Center, Cliniques Universitaires St. Luc, Institut de Recherche Clinique et Experimentale, Brussels, Belgium. 13. Heart Institute - InCor - University of São Paulo Medical School, São Paulo, Brazil. 14. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 15. Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 16. Department Cardiology B, Aarhus University Hospital Skejby, Aarhus, Denmark. 17. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 18. Turku University Hospital and University of Turku, Turku, Finland. 19. Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. 20. Department of Radiology, University of Regensburg, Regensburg, Germany. 21. Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK. 22. Department of Cardiology, Odense University Hospital, Odense, Denmark. 23. Department of Cardiology Lillebælt Hospital -Vejle, Vejle, Denmark. 24. Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. 25. Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel. 26. Medical Department, Ostfold Hospital Trust, Fredrikstad, Norway. 27. National Institute of Cardiology and Cardiovascular, Surgery, Havana, Cuba. 28. Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 29. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. 30. Medizinische Klinik I (Kardiologie, Angiologie), Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany. 31. Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait. 32. Mubarak Al Kabeer Hospital, Jabriya, Kuwait. 33. Klinik für Innere Medizin III mit Schwerpunkt Kardiologie und Angiologie, UKSH, Kiel, Germany. 34. Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany. 35. Cardiologie diagnostique et interventionnelle, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. 36. Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy. 37. Department of Medicine, St. Luke's International Hospital, Tokyo, Japan. 38. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 39. Department of Diagnostic and Interventional Radiology, Eberhard Karls Universität Tübingen, Tübingen, Germany. 40. Aleris Hospital, Oslo, Norway. 41. Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 42. Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. 43. Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 44. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland. 45. Department of Radiology, Beth Israel Deaconess, Harvard University, Boston, MA, USA. 46. Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel. 47. Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 48. Department of Radiology and Division of Cardiology UBC, St Paul's Hospital, Vancouver, Canada. 49. Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA. 50. Department of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. 51. Department of Interventional Cardiology, University Hospital Cochin, Paris, France. 52. Department of Radiology, Baotou Central Hospital, Baotou Shi, Inner Mongolia Province, China. 53. Department of Clinical Radiology, Hospital Grosshadern of the University of Munich, Munich, Germany. 54. Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France. 55. Department of Clinical Radiology, Munich, Ludwig-Maximilians-University of Munich, Munich, Germany. 56. Cardiology Department, S. Chiara Hospital, Trento, Italy. 57. Research Center Montreal Heart Institute, Université de Montréal, Montréal, Canada. 58. University of Ottawa, Heart Institute, Ottawa, Canada. 59. Joint Department of Medical Imaging, University Health Network, Mount Sinai and Women's College Hospitals, Toronto, Canada. 60. University of Toronto, Toronto, Canada. 61. Institute and Polyclinic for Diagnostic Radiology, University of Cologne, Cologne, Germany. 62. Department of Diagnostic Radiology, Mt Elizabeth Hospital, Singapore, Singapore. 63. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 64. Department of Cardiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany. 65. Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich Schiller University Jena, Jena, Germany. 66. Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany. marc.dewey@charite.de.
Abstract
OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.
OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.
Entities:
Keywords:
Coronary artery disease; Duke clinical score; Multidetector computed tomography; NICE clinical guideline; Pretest probability
Authors: Tessa S S Genders; Ewout W Steyerberg; Hatem Alkadhi; Sebastian Leschka; Lotus Desbiolles; Koen Nieman; Tjebbe W Galema; W Bob Meijboom; Nico R Mollet; Pim J de Feyter; Filippo Cademartiri; Erica Maffei; Marc Dewey; Elke Zimmermann; Michael Laule; Francesca Pugliese; Rossella Barbagallo; Valentin Sinitsyn; Jan Bogaert; Kaatje Goetschalckx; U Joseph Schoepf; Garrett W Rowe; Joanne D Schuijf; Jeroen J Bax; Fleur R de Graaf; Juhani Knuuti; Sami Kajander; Carlos A G van Mieghem; Matthijs F L Meijs; Maarten J Cramer; Deepa Gopalan; Gudrun Feuchtner; Guy Friedrich; Gabriel P Krestin; M G Myriam Hunink Journal: Eur Heart J Date: 2011-03-02 Impact factor: 29.983
Authors: W Bob Meijboom; Matthijs F L Meijs; Joanne D Schuijf; Maarten J Cramer; Nico R Mollet; Carlos A G van Mieghem; Koen Nieman; Jacob M van Werkhoven; Gabija Pundziute; Annick C Weustink; Alexander M de Vos; Francesca Pugliese; Benno Rensing; J Wouter Jukema; Jeroen J Bax; Mathias Prokop; Pieter A Doevendans; Myriam G M Hunink; Gabriel P Krestin; Pim J de Feyter Journal: J Am Coll Cardiol Date: 2008-12-16 Impact factor: 24.094
Authors: D B Pryor; L Shaw; C B McCants; K L Lee; D B Mark; F E Harrell; L H Muhlbaier; R M Califf Journal: Ann Intern Med Date: 1993-01-15 Impact factor: 25.391
Authors: Manesh R Patel; David Dai; Adrian F Hernandez; Pamela S Douglas; John Messenger; Kirk N Garratt; Thomas M Maddox; Eric D Peterson; Matthew T Roe Journal: Am Heart J Date: 2014-03-14 Impact factor: 4.749
Authors: Georg M Schuetz; Peter Schlattmann; Stephan Achenbach; Matthew Budoff; Mario J Garcia; Robert Roehle; Gianluca Pontone; Willem Bob Meijboom; Daniele Andreini; Hatem Alkadhi; Lily Honoris; Nuno Bettencourt; Jörg Hausleiter; Sebastian Leschka; Bernhard L Gerber; Matthijs Fl Meijs; Abbas Arjmand Shabestari; Akira Sato; Elke Zimmermann; Uwe J Schoepf; Axel Diederichsen; David A Halon; Vladimir Mendoza-Rodriguez; Ashraf Hamdan; Bjarne L Nørgaard; Harald Brodoefel; Kristian A Ovrehus; Shona Mm Jenkins; Bjørn A Halvorsen; Johannes Rixe; Mehraj Sheikh; Christoph Langer; Eugenio Martuscelli; Andrea Romagnoli; Arthur Jha Scholte; Roy P Marcus; Geir R Ulimoen; Koen Nieman; Hans Mickley; Konstantin Nikolaou; Jean-Claude Tardif; Thorsten Rc Johnson; Simone Muraglia; Benjamin Jw Chow; David Maintz; Michael Laule; Marc Dewey Journal: Syst Rev Date: 2013-02-15