Simon Winther1, Samuel Emil Schmidt2, Laust Dupont Rasmussen1, Luis Eduardo Juárez Orozco3, Flemming Hald Steffensen4,5, Hans Erik Bøtker6, Juhani Knuuti3, Morten Bøttcher1. 1. Department of Cardiology, Gødstrup Hospital, Gl. Landevej 61, Herning 7400, Denmark. 2. Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D2. 9220 Aalborg Øst, Denmark. 3. Department of Clinical Physiology, Nuclear Medicine and PET and Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, FI20520 Turku, Finland. 4. Department of Cardiology, Lillebaelt Hospital, Kabbeltoft 25, 7100 Vejle, Denmark. 5. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45. 8200 Aarhus N, Denmark. 6. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark.
Abstract
AIMS: Estimation of pre-test probability (PTP) of disease in patients with suspected coronary artery disease (CAD) is a common challenge. Due to decreasing prevalence of obstructive CAD in patients referred for diagnostic testing, the European Society of Cardiology suggested a new PTP (2019-ESC-PTP) model. The aim of this study was to validate that model. METHODS AND RESULTS: Symptomatic patients referred for coronary computed tomography angiography (CTA) due to suspected CAD in a geographical uptake area of 3.3 million inhabitants were included. The reference standard was a combined endpoint of CTA and invasive coronary angiography (ICA) with obstructive CAD defined at ICA as a ≥50% diameter stenosis or fractional flow reserve ≤0.80 when performed. The 2019-ESC-PTP, 2013-ESC-PTP, and CAD Consortium basic PTP scores were calculated based on age, sex, and symptoms. Of the 42 328 identified patients, coronary stenosis was detected in 8.8% using the combined endpoint. The 2019-ESC-PTP and CAD Consortium basic scores classified substantially more patients into the low PTP groups (PTP < 15%) than did the 2013-ESC-PTP (64% and 65% vs. 16%, P < 0.001). Using the combined endpoint as reference, calibration of the 2019-ESC-PTP model was superior to the 2013-ESC-PTP and CAD Consortium basic score. CONCLUSION: The new 2019-ESC-PTP model is well calibrated and superior to the previously recommended models in predicting obstructive stenosis detected by a combined endpoint of CTA and ICA. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Estimation of pre-test probability (PTP) of disease in patients with suspected coronary artery disease (CAD) is a common challenge. Due to decreasing prevalence of obstructive CAD in patients referred for diagnostic testing, the European Society of Cardiology suggested a new PTP (2019-ESC-PTP) model. The aim of this study was to validate that model. METHODS AND RESULTS: Symptomatic patients referred for coronary computed tomography angiography (CTA) due to suspected CAD in a geographical uptake area of 3.3 million inhabitants were included. The reference standard was a combined endpoint of CTA and invasive coronary angiography (ICA) with obstructive CAD defined at ICA as a ≥50% diameter stenosis or fractional flow reserve ≤0.80 when performed. The 2019-ESC-PTP, 2013-ESC-PTP, and CAD Consortium basic PTP scores were calculated based on age, sex, and symptoms. Of the 42 328 identified patients, coronary stenosis was detected in 8.8% using the combined endpoint. The 2019-ESC-PTP and CAD Consortium basic scores classified substantially more patients into the low PTP groups (PTP < 15%) than did the 2013-ESC-PTP (64% and 65% vs. 16%, P < 0.001). Using the combined endpoint as reference, calibration of the 2019-ESC-PTP model was superior to the 2013-ESC-PTP and CAD Consortium basic score. CONCLUSION: The new 2019-ESC-PTP model is well calibrated and superior to the previously recommended models in predicting obstructive stenosis detected by a combined endpoint of CTA and ICA. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Dario Tino Bertolone; Emanuele Gallinoro; Giuseppe Esposito; Pasquale Paolisso; Konstantinos Bermpeis; Cristina De Colle; Davide Fabbricatore; Niya Mileva; Chiara Valeriano; Daniel Munhoz; Marta Belmonte; Marc Vanderheyden; Jozef Bartunek; Jeroen Sonck; Eric Wyffels; Carlos Collet; Costantino Mancusi; Carmine Morisco; Nicola De Luca; Bernard De Bruyne; Emanuele Barbato Journal: High Blood Press Cardiovasc Prev Date: 2022-02-11