Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease: a prospective study with a fractional flow reserve endpoint

Evald Høj Christiansen, B Hans Erik, Jelmer Westra, Niels Ramsing Holm, Simon Winther, Lars Lyhne Knudsen, Lene Helleskov Madsen, Louise Nissen, B Morten, Nadia Bouteldja, Samuel Emil Schmidt, Grazina Urbonaviciene, Lars Frost

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

European and North American guidelines currently recommend pre-test probability (PTP) stratification based on simple probability models in patients with suspected coronary artery disease (CAD). However, no unequivocal recommendation has yet been established. We aimed to compare the ability of risk factors and different PTP stratification models to predict haemodynamically obstructive CAD with fractional flow reserve (FFR) as reference in low to intermediate probability patients.We prospectively included 1675 patients with low to intermediate risk who had been referred to coronary computed tomography angiography (CTA). Patients with coronary stenosis were subsequently investigated by invasive coronary angiography (ICA) with FFR measurement if indicated. Discrimination and calibration were assessed for four models: the updated Diamond\Forrester (UDF), the CAD Consortium Basic, the Clinical, and the Clinical\ +\ Coronary artery calcium score (CACS). At coronary CTA, 24\% of patients were diagnosed with a suspected stenosis and 10\% had haemodynamically obstructive CAD at the ICA. Calibration for all CAD Consortium models increased compared with the UDF score. However, all models overestimated the probability of haemodynamically obstructive CAD. Discrimination increased by area under the receiver operating curve from 67\% to 86\% for UDF vs. CAD Consortium Clinical\ +\ CACS. The proportion of low-probability patients (pre-test score\ \lt;\ 15\ was for the UDF, CAD Consortium Basic, Clinical, and Clinical\ +\ CACS: 14\ 58\ 51\ and 66\ respectively. The corresponding negative predictive values were 97\ 94\ 95\ and 98\ respectively.CAD Consortium models improve PTP stratification compared with the UDF score, mainly due to superior calibration in low to intermediate probability patients. Adding the coronary calcium score to the models substantially increases discrimination.NCT02264717.
OriginalsprogEngelsk
TidsskriftEuropean Heart Journal Cardiovascular Imaging
ISSN1525-2167
DOI
StatusE-pub ahead of print - 9 apr. 2019

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Coronary Artery Disease
Prospective Studies
Diamond
Calibration
Calcium
Coronary Vessels
Coronary Angiography
Coronary Stenosis
Pathologic Constriction
Guidelines

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Christiansen, Evald Høj ; Erik, B Hans ; Westra, Jelmer ; Holm, Niels Ramsing ; Winther, Simon ; Knudsen, Lars Lyhne ; Madsen, Lene Helleskov ; Nissen, Louise ; Morten, B ; Bouteldja, Nadia ; Schmidt, Samuel Emil ; Urbonaviciene, Grazina ; Frost, Lars. / Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease: a prospective study with a fractional flow reserve endpoint. I: European Heart Journal Cardiovascular Imaging. 2019.
@article{45e5dd259c96421393d80ff5e12c1c1e,
title = "Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease: a prospective study with a fractional flow reserve endpoint",
abstract = "European and North American guidelines currently recommend pre-test probability (PTP) stratification based on simple probability models in patients with suspected coronary artery disease (CAD). However, no unequivocal recommendation has yet been established. We aimed to compare the ability of risk factors and different PTP stratification models to predict haemodynamically obstructive CAD with fractional flow reserve (FFR) as reference in low to intermediate probability patients.We prospectively included 1675 patients with low to intermediate risk who had been referred to coronary computed tomography angiography (CTA). Patients with coronary stenosis were subsequently investigated by invasive coronary angiography (ICA) with FFR measurement if indicated. Discrimination and calibration were assessed for four models: the updated Diamond\Forrester (UDF), the CAD Consortium Basic, the Clinical, and the Clinical\ +\ Coronary artery calcium score (CACS). At coronary CTA, 24\{\%} of patients were diagnosed with a suspected stenosis and 10\{\%} had haemodynamically obstructive CAD at the ICA. Calibration for all CAD Consortium models increased compared with the UDF score. However, all models overestimated the probability of haemodynamically obstructive CAD. Discrimination increased by area under the receiver operating curve from 67\{\%} to 86\{\%} for UDF vs. CAD Consortium Clinical\ +\ CACS. The proportion of low-probability patients (pre-test score\ \lt;\ 15\ was for the UDF, CAD Consortium Basic, Clinical, and Clinical\ +\ CACS: 14\ 58\ 51\ and 66\ respectively. The corresponding negative predictive values were 97\ 94\ 95\ and 98\ respectively.CAD Consortium models improve PTP stratification compared with the UDF score, mainly due to superior calibration in low to intermediate probability patients. Adding the coronary calcium score to the models substantially increases discrimination.NCT02264717.",
author = "Christiansen, {Evald H{\o}j} and Erik, {B Hans} and Jelmer Westra and Holm, {Niels Ramsing} and Simon Winther and Knudsen, {Lars Lyhne} and Madsen, {Lene Helleskov} and Louise Nissen and B Morten and Nadia Bouteldja and Schmidt, {Samuel Emil} and Grazina Urbonaviciene and Lars Frost",
year = "2019",
month = "4",
day = "9",
doi = "10.1093/ehjci/jez058",
language = "English",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "1525-2167",
publisher = "Oxford University Press",

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Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease: a prospective study with a fractional flow reserve endpoint. / Christiansen, Evald Høj; Erik, B Hans; Westra, Jelmer; Holm, Niels Ramsing; Winther, Simon; Knudsen, Lars Lyhne; Madsen, Lene Helleskov; Nissen, Louise; Morten, B; Bouteldja, Nadia; Schmidt, Samuel Emil; Urbonaviciene, Grazina; Frost, Lars.

I: European Heart Journal Cardiovascular Imaging, 09.04.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease: a prospective study with a fractional flow reserve endpoint

AU - Christiansen, Evald Høj

AU - Erik, B Hans

AU - Westra, Jelmer

AU - Holm, Niels Ramsing

AU - Winther, Simon

AU - Knudsen, Lars Lyhne

AU - Madsen, Lene Helleskov

AU - Nissen, Louise

AU - Morten, B

AU - Bouteldja, Nadia

AU - Schmidt, Samuel Emil

AU - Urbonaviciene, Grazina

AU - Frost, Lars

PY - 2019/4/9

Y1 - 2019/4/9

N2 - European and North American guidelines currently recommend pre-test probability (PTP) stratification based on simple probability models in patients with suspected coronary artery disease (CAD). However, no unequivocal recommendation has yet been established. We aimed to compare the ability of risk factors and different PTP stratification models to predict haemodynamically obstructive CAD with fractional flow reserve (FFR) as reference in low to intermediate probability patients.We prospectively included 1675 patients with low to intermediate risk who had been referred to coronary computed tomography angiography (CTA). Patients with coronary stenosis were subsequently investigated by invasive coronary angiography (ICA) with FFR measurement if indicated. Discrimination and calibration were assessed for four models: the updated Diamond\Forrester (UDF), the CAD Consortium Basic, the Clinical, and the Clinical\ +\ Coronary artery calcium score (CACS). At coronary CTA, 24\% of patients were diagnosed with a suspected stenosis and 10\% had haemodynamically obstructive CAD at the ICA. Calibration for all CAD Consortium models increased compared with the UDF score. However, all models overestimated the probability of haemodynamically obstructive CAD. Discrimination increased by area under the receiver operating curve from 67\% to 86\% for UDF vs. CAD Consortium Clinical\ +\ CACS. The proportion of low-probability patients (pre-test score\ \lt;\ 15\ was for the UDF, CAD Consortium Basic, Clinical, and Clinical\ +\ CACS: 14\ 58\ 51\ and 66\ respectively. The corresponding negative predictive values were 97\ 94\ 95\ and 98\ respectively.CAD Consortium models improve PTP stratification compared with the UDF score, mainly due to superior calibration in low to intermediate probability patients. Adding the coronary calcium score to the models substantially increases discrimination.NCT02264717.

AB - European and North American guidelines currently recommend pre-test probability (PTP) stratification based on simple probability models in patients with suspected coronary artery disease (CAD). However, no unequivocal recommendation has yet been established. We aimed to compare the ability of risk factors and different PTP stratification models to predict haemodynamically obstructive CAD with fractional flow reserve (FFR) as reference in low to intermediate probability patients.We prospectively included 1675 patients with low to intermediate risk who had been referred to coronary computed tomography angiography (CTA). Patients with coronary stenosis were subsequently investigated by invasive coronary angiography (ICA) with FFR measurement if indicated. Discrimination and calibration were assessed for four models: the updated Diamond\Forrester (UDF), the CAD Consortium Basic, the Clinical, and the Clinical\ +\ Coronary artery calcium score (CACS). At coronary CTA, 24\% of patients were diagnosed with a suspected stenosis and 10\% had haemodynamically obstructive CAD at the ICA. Calibration for all CAD Consortium models increased compared with the UDF score. However, all models overestimated the probability of haemodynamically obstructive CAD. Discrimination increased by area under the receiver operating curve from 67\% to 86\% for UDF vs. CAD Consortium Clinical\ +\ CACS. The proportion of low-probability patients (pre-test score\ \lt;\ 15\ was for the UDF, CAD Consortium Basic, Clinical, and Clinical\ +\ CACS: 14\ 58\ 51\ and 66\ respectively. The corresponding negative predictive values were 97\ 94\ 95\ and 98\ respectively.CAD Consortium models improve PTP stratification compared with the UDF score, mainly due to superior calibration in low to intermediate probability patients. Adding the coronary calcium score to the models substantially increases discrimination.NCT02264717.

U2 - 10.1093/ehjci/jez058

DO - 10.1093/ehjci/jez058

M3 - Journal article

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 1525-2167

ER -