Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study
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 tom...
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| Veröffentlicht in: | European radiology 2021-03, Vol.31 (3), p.1471-1481 |
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| creator | Feger, Sarah Ibes, Paolo Napp, Adriane E. Lembcke, Alexander Laule, Michael Dreger, Henryk Bokelmann, Björn Davis, Gershan K. Roditi, Giles Diez, Ignacio Schröder, Stephen Plank, Fabian Maurovich-Horvat, Pal Vidakovic, Radosav Veselka, Josef Ilnicka-Suckiel, Malgorzata Erglis, Andrejs Benedek, Teodora Rodriguez-Palomares, José Saba, Luca Kofoed, Klaus F. Gutberlet, Matthias Ađić, Filip Pietilä, Mikko Faria, Rita Vaitiekiene, Audrone Dodd, Jonathan D. Donnelly, Patrick Francone, Marco Kepka, Cezary Ruzsics, Balazs Müller-Nordhorn, Jacqueline Schlattmann, Peter Dewey, Marc |
| description | 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. |
| doi_str_mv | 10.1007/s00330-020-07175-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7880945</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2488774834</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-525f75b59110e3fb344b7e25b5fb4a3f31b225d411f15e926f1a7dcb786aa2a03</originalsourceid><addsrcrecordid>eNp9kUtv1DAUhS0EotPCH2CBLLFhE_ArccwCqRqmD6kSEo-1ZSfXM64ycbCdoumvx2X6oCy6sK7l-91jHx-E3lDygRIiPyZCOCcVYWVJKuvq-hlaUMFZRUkrnqMFUbytpFLiAB2mdEkIUVTIl-iAM0WYFHyBfi8HP_rODHiKUGVIuWyCNdYPPu-wCxEHm3Kcu-yvAHchhtHEHTYxQym9T2ASfMJ-TH69yQm7GLY4bwCv5hgmMCP-cv59eXb87XSFJz-EjFOe-90r9MKZIcHr23qEfp6sfizPqouvp-fL44uqE1Lkqma1k7WtFaUEuLNcCCuBlRNnheGOU8tY3QtKHa1BscZRI_vOyrYxhhnCj9Dnve402y30HYw5mkFP0W-LDR2M1487o9_odbjSsm2JEnUReH8rEMOvufyP3vrUwTCYEcKcNBOCsqZRzQ367j_0MsxxLPYK1bZSipaLQrE91cWQUgR3_xhK9E2uep-rLrnqv7nq6zL09l8b9yN3QRaA74FUWuMa4sPdT8j-AfsxsK8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2488774834</pqid></control><display><type>article</type><title>Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Feger, Sarah ; Ibes, Paolo ; Napp, Adriane E. ; Lembcke, Alexander ; Laule, Michael ; Dreger, Henryk ; Bokelmann, Björn ; Davis, Gershan K. ; Roditi, Giles ; Diez, Ignacio ; Schröder, Stephen ; Plank, Fabian ; Maurovich-Horvat, Pal ; Vidakovic, Radosav ; Veselka, Josef ; Ilnicka-Suckiel, Malgorzata ; Erglis, Andrejs ; Benedek, Teodora ; Rodriguez-Palomares, José ; Saba, Luca ; Kofoed, Klaus F. ; Gutberlet, Matthias ; Ađić, Filip ; Pietilä, Mikko ; Faria, Rita ; Vaitiekiene, Audrone ; Dodd, Jonathan D. ; Donnelly, Patrick ; Francone, Marco ; Kepka, Cezary ; Ruzsics, Balazs ; Müller-Nordhorn, Jacqueline ; Schlattmann, Peter ; Dewey, Marc</creator><creatorcontrib>Feger, Sarah ; Ibes, Paolo ; Napp, Adriane E. ; Lembcke, Alexander ; Laule, Michael ; Dreger, Henryk ; Bokelmann, Björn ; Davis, Gershan K. ; Roditi, Giles ; Diez, Ignacio ; Schröder, Stephen ; Plank, Fabian ; Maurovich-Horvat, Pal ; Vidakovic, Radosav ; Veselka, Josef ; Ilnicka-Suckiel, Malgorzata ; Erglis, Andrejs ; Benedek, Teodora ; Rodriguez-Palomares, José ; Saba, Luca ; Kofoed, Klaus F. ; Gutberlet, Matthias ; Ađić, Filip ; Pietilä, Mikko ; Faria, Rita ; Vaitiekiene, Audrone ; Dodd, Jonathan D. ; Donnelly, Patrick ; Francone, Marco ; Kepka, Cezary ; Ruzsics, Balazs ; Müller-Nordhorn, Jacqueline ; Schlattmann, Peter ; Dewey, Marc</creatorcontrib><description>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.</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-020-07175-z</identifier><identifier>PMID: 32902743</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Accuracy ; Angiography ; Cardiovascular disease ; Chest ; Clinical decision making ; Computed Tomography ; Computed Tomography Angiography ; Confidence intervals ; Coronary Angiography ; Coronary artery ; Coronary artery disease ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - epidemiology ; Coronary Stenosis - diagnostic imaging ; Coronary Stenosis - epidemiology ; Coronary vessels ; Decision making ; Diagnostic Radiology ; Diagnostic systems ; Diamonds ; Europe ; Female ; Heart diseases ; Humans ; Imaging ; Internal Medicine ; Interventional Radiology ; Male ; Medicine ; Medicine & Public Health ; Neuroradiology ; Pain ; Patient Discharge ; Pilot Projects ; Prediction models ; Predictive Value of Tests ; Radiology ; Reclassification ; Risk Assessment ; Risk Factors ; Statistical analysis ; Stenosis ; Ultrasound</subject><ispartof>European radiology, 2021-03, Vol.31 (3), p.1471-1481</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-525f75b59110e3fb344b7e25b5fb4a3f31b225d411f15e926f1a7dcb786aa2a03</citedby><cites>FETCH-LOGICAL-c474t-525f75b59110e3fb344b7e25b5fb4a3f31b225d411f15e926f1a7dcb786aa2a03</cites><orcidid>0000-0002-4402-2733</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-020-07175-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-020-07175-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32902743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feger, Sarah</creatorcontrib><creatorcontrib>Ibes, Paolo</creatorcontrib><creatorcontrib>Napp, Adriane E.</creatorcontrib><creatorcontrib>Lembcke, Alexander</creatorcontrib><creatorcontrib>Laule, Michael</creatorcontrib><creatorcontrib>Dreger, Henryk</creatorcontrib><creatorcontrib>Bokelmann, Björn</creatorcontrib><creatorcontrib>Davis, Gershan K.</creatorcontrib><creatorcontrib>Roditi, Giles</creatorcontrib><creatorcontrib>Diez, Ignacio</creatorcontrib><creatorcontrib>Schröder, Stephen</creatorcontrib><creatorcontrib>Plank, Fabian</creatorcontrib><creatorcontrib>Maurovich-Horvat, Pal</creatorcontrib><creatorcontrib>Vidakovic, Radosav</creatorcontrib><creatorcontrib>Veselka, Josef</creatorcontrib><creatorcontrib>Ilnicka-Suckiel, Malgorzata</creatorcontrib><creatorcontrib>Erglis, Andrejs</creatorcontrib><creatorcontrib>Benedek, Teodora</creatorcontrib><creatorcontrib>Rodriguez-Palomares, José</creatorcontrib><creatorcontrib>Saba, Luca</creatorcontrib><creatorcontrib>Kofoed, Klaus F.</creatorcontrib><creatorcontrib>Gutberlet, Matthias</creatorcontrib><creatorcontrib>Ađić, Filip</creatorcontrib><creatorcontrib>Pietilä, Mikko</creatorcontrib><creatorcontrib>Faria, Rita</creatorcontrib><creatorcontrib>Vaitiekiene, Audrone</creatorcontrib><creatorcontrib>Dodd, Jonathan D.</creatorcontrib><creatorcontrib>Donnelly, Patrick</creatorcontrib><creatorcontrib>Francone, Marco</creatorcontrib><creatorcontrib>Kepka, Cezary</creatorcontrib><creatorcontrib>Ruzsics, Balazs</creatorcontrib><creatorcontrib>Müller-Nordhorn, Jacqueline</creatorcontrib><creatorcontrib>Schlattmann, Peter</creatorcontrib><creatorcontrib>Dewey, Marc</creatorcontrib><title>Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>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.</description><subject>Accuracy</subject><subject>Angiography</subject><subject>Cardiovascular disease</subject><subject>Chest</subject><subject>Clinical decision making</subject><subject>Computed Tomography</subject><subject>Computed Tomography Angiography</subject><subject>Confidence intervals</subject><subject>Coronary Angiography</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Coronary Stenosis - epidemiology</subject><subject>Coronary vessels</subject><subject>Decision making</subject><subject>Diagnostic Radiology</subject><subject>Diagnostic systems</subject><subject>Diamonds</subject><subject>Europe</subject><subject>Female</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuroradiology</subject><subject>Pain</subject><subject>Patient Discharge</subject><subject>Pilot Projects</subject><subject>Prediction models</subject><subject>Predictive Value of Tests</subject><subject>Radiology</subject><subject>Reclassification</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><subject>Stenosis</subject><subject>Ultrasound</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kUtv1DAUhS0EotPCH2CBLLFhE_ArccwCqRqmD6kSEo-1ZSfXM64ycbCdoumvx2X6oCy6sK7l-91jHx-E3lDygRIiPyZCOCcVYWVJKuvq-hlaUMFZRUkrnqMFUbytpFLiAB2mdEkIUVTIl-iAM0WYFHyBfi8HP_rODHiKUGVIuWyCNdYPPu-wCxEHm3Kcu-yvAHchhtHEHTYxQym9T2ASfMJ-TH69yQm7GLY4bwCv5hgmMCP-cv59eXb87XSFJz-EjFOe-90r9MKZIcHr23qEfp6sfizPqouvp-fL44uqE1Lkqma1k7WtFaUEuLNcCCuBlRNnheGOU8tY3QtKHa1BscZRI_vOyrYxhhnCj9Dnve402y30HYw5mkFP0W-LDR2M1487o9_odbjSsm2JEnUReH8rEMOvufyP3vrUwTCYEcKcNBOCsqZRzQ367j_0MsxxLPYK1bZSipaLQrE91cWQUgR3_xhK9E2uep-rLrnqv7nq6zL09l8b9yN3QRaA74FUWuMa4sPdT8j-AfsxsK8</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Feger, Sarah</creator><creator>Ibes, Paolo</creator><creator>Napp, Adriane E.</creator><creator>Lembcke, Alexander</creator><creator>Laule, Michael</creator><creator>Dreger, Henryk</creator><creator>Bokelmann, Björn</creator><creator>Davis, Gershan K.</creator><creator>Roditi, Giles</creator><creator>Diez, Ignacio</creator><creator>Schröder, Stephen</creator><creator>Plank, Fabian</creator><creator>Maurovich-Horvat, Pal</creator><creator>Vidakovic, Radosav</creator><creator>Veselka, Josef</creator><creator>Ilnicka-Suckiel, Malgorzata</creator><creator>Erglis, Andrejs</creator><creator>Benedek, Teodora</creator><creator>Rodriguez-Palomares, José</creator><creator>Saba, Luca</creator><creator>Kofoed, Klaus F.</creator><creator>Gutberlet, Matthias</creator><creator>Ađić, Filip</creator><creator>Pietilä, Mikko</creator><creator>Faria, Rita</creator><creator>Vaitiekiene, Audrone</creator><creator>Dodd, Jonathan D.</creator><creator>Donnelly, Patrick</creator><creator>Francone, 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pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study</title><author>Feger, Sarah ; Ibes, Paolo ; Napp, Adriane E. ; Lembcke, Alexander ; Laule, Michael ; Dreger, Henryk ; Bokelmann, Björn ; Davis, Gershan K. ; Roditi, Giles ; Diez, Ignacio ; Schröder, Stephen ; Plank, Fabian ; Maurovich-Horvat, Pal ; Vidakovic, Radosav ; Veselka, Josef ; Ilnicka-Suckiel, Malgorzata ; Erglis, Andrejs ; Benedek, Teodora ; Rodriguez-Palomares, José ; Saba, Luca ; Kofoed, Klaus F. ; Gutberlet, Matthias ; Ađić, Filip ; Pietilä, Mikko ; Faria, Rita ; Vaitiekiene, Audrone ; Dodd, Jonathan D. ; Donnelly, Patrick ; Francone, Marco ; Kepka, Cezary ; Ruzsics, Balazs ; Müller-Nordhorn, Jacqueline ; Schlattmann, Peter ; Dewey, Marc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-525f75b59110e3fb344b7e25b5fb4a3f31b225d411f15e926f1a7dcb786aa2a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Accuracy</topic><topic>Angiography</topic><topic>Cardiovascular disease</topic><topic>Chest</topic><topic>Clinical decision making</topic><topic>Computed Tomography</topic><topic>Computed Tomography Angiography</topic><topic>Confidence intervals</topic><topic>Coronary Angiography</topic><topic>Coronary artery</topic><topic>Coronary artery disease</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - epidemiology</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Coronary Stenosis - epidemiology</topic><topic>Coronary vessels</topic><topic>Decision making</topic><topic>Diagnostic Radiology</topic><topic>Diagnostic systems</topic><topic>Diamonds</topic><topic>Europe</topic><topic>Female</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuroradiology</topic><topic>Pain</topic><topic>Patient Discharge</topic><topic>Pilot Projects</topic><topic>Prediction models</topic><topic>Predictive Value of Tests</topic><topic>Radiology</topic><topic>Reclassification</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Statistical analysis</topic><topic>Stenosis</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feger, Sarah</creatorcontrib><creatorcontrib>Ibes, Paolo</creatorcontrib><creatorcontrib>Napp, Adriane E.</creatorcontrib><creatorcontrib>Lembcke, Alexander</creatorcontrib><creatorcontrib>Laule, Michael</creatorcontrib><creatorcontrib>Dreger, Henryk</creatorcontrib><creatorcontrib>Bokelmann, Björn</creatorcontrib><creatorcontrib>Davis, Gershan K.</creatorcontrib><creatorcontrib>Roditi, Giles</creatorcontrib><creatorcontrib>Diez, Ignacio</creatorcontrib><creatorcontrib>Schröder, Stephen</creatorcontrib><creatorcontrib>Plank, Fabian</creatorcontrib><creatorcontrib>Maurovich-Horvat, Pal</creatorcontrib><creatorcontrib>Vidakovic, Radosav</creatorcontrib><creatorcontrib>Veselka, Josef</creatorcontrib><creatorcontrib>Ilnicka-Suckiel, Malgorzata</creatorcontrib><creatorcontrib>Erglis, Andrejs</creatorcontrib><creatorcontrib>Benedek, Teodora</creatorcontrib><creatorcontrib>Rodriguez-Palomares, José</creatorcontrib><creatorcontrib>Saba, Luca</creatorcontrib><creatorcontrib>Kofoed, Klaus F.</creatorcontrib><creatorcontrib>Gutberlet, Matthias</creatorcontrib><creatorcontrib>Ađić, Filip</creatorcontrib><creatorcontrib>Pietilä, Mikko</creatorcontrib><creatorcontrib>Faria, Rita</creatorcontrib><creatorcontrib>Vaitiekiene, Audrone</creatorcontrib><creatorcontrib>Dodd, Jonathan D.</creatorcontrib><creatorcontrib>Donnelly, Patrick</creatorcontrib><creatorcontrib>Francone, Marco</creatorcontrib><creatorcontrib>Kepka, Cezary</creatorcontrib><creatorcontrib>Ruzsics, Balazs</creatorcontrib><creatorcontrib>Müller-Nordhorn, Jacqueline</creatorcontrib><creatorcontrib>Schlattmann, Peter</creatorcontrib><creatorcontrib>Dewey, Marc</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feger, Sarah</au><au>Ibes, Paolo</au><au>Napp, Adriane E.</au><au>Lembcke, Alexander</au><au>Laule, Michael</au><au>Dreger, Henryk</au><au>Bokelmann, Björn</au><au>Davis, Gershan K.</au><au>Roditi, Giles</au><au>Diez, Ignacio</au><au>Schröder, Stephen</au><au>Plank, Fabian</au><au>Maurovich-Horvat, Pal</au><au>Vidakovic, Radosav</au><au>Veselka, Josef</au><au>Ilnicka-Suckiel, Malgorzata</au><au>Erglis, Andrejs</au><au>Benedek, Teodora</au><au>Rodriguez-Palomares, José</au><au>Saba, Luca</au><au>Kofoed, Klaus F.</au><au>Gutberlet, Matthias</au><au>Ađić, Filip</au><au>Pietilä, Mikko</au><au>Faria, Rita</au><au>Vaitiekiene, Audrone</au><au>Dodd, Jonathan D.</au><au>Donnelly, Patrick</au><au>Francone, Marco</au><au>Kepka, Cezary</au><au>Ruzsics, Balazs</au><au>Müller-Nordhorn, Jacqueline</au><au>Schlattmann, Peter</au><au>Dewey, Marc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>31</volume><issue>3</issue><spage>1471</spage><epage>1481</epage><pages>1471-1481</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32902743</pmid><doi>10.1007/s00330-020-07175-z</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4402-2733</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2021-03, Vol.31 (3), p.1471-1481 |
| issn | 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7880945 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Accuracy Angiography Cardiovascular disease Chest Clinical decision making Computed Tomography Computed Tomography Angiography Confidence intervals Coronary Angiography Coronary artery Coronary artery disease Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - epidemiology Coronary Stenosis - diagnostic imaging Coronary Stenosis - epidemiology Coronary vessels Decision making Diagnostic Radiology Diagnostic systems Diamonds Europe Female Heart diseases Humans Imaging Internal Medicine Interventional Radiology Male Medicine Medicine & Public Health Neuroradiology Pain Patient Discharge Pilot Projects Prediction models Predictive Value of Tests Radiology Reclassification Risk Assessment Risk Factors Statistical analysis Stenosis Ultrasound |
| title | Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study |
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