Identification of patients with stable chest pain deriving minimal value from coronary computed tomography angiography: An external validation of the PROMISE minimal-risk tool. (1st February 2018)

• Record Type: Journal Article
• Authors: Adamson, Philip D.; Fordyce, Christopher B.; McAllister, David A.; Udelson, James E.; Douglas, Pamela S.; Newby, David E.
• Is Part Of: International journal of cardiology. Volume 252(2018)
• Page Start: 31
• Page End: 34
• Publication Date: 2018-02-01
• Subjects: PROMISE PROspective Multicenter Imaging Study for Evaluation of chest pain -- SCOT-HEART Scottish COmputed Tomography of the HEART -- CCTA coronary computed tomography angiography -- CAD coronary artery disease -- CADC Coronary Artery Disease Consortium -- HL Hosmer-Lemeshow -- MICE-PMM multiple imputation using regression switching with predictive mean matching; Stable angina -- Coronary artery disease -- Coronary computed tomography angiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.09.033
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) minimal-risk tool was recently developed to identify patients with suspected stable angina at very low risk of coronary artery disease (CAD) and clinical events. We assessed the external validity of this tool within the context of the Scottish Computed Tomography of the HEART (SCOT-HEART) multicenter randomised controlled trial of patients with suspected stable angina due to coronary disease. Methods: The minimal-risk tool was applied to 1764 patients with complete imaging and follow-up data. External validity was compared with the guideline-endorsed CAD Consortium (CADC) risk score and determined through tests of model discrimination and calibration. Results: A total of 531 (30.1%, mean age 52.4 years, female 62.0%) patients were classified as minimal-risk. Compared to the remainder of the validation cohort, this group had lower estimated pre-test probability of coronary disease according to the CADC model (30.0% vs 47.0%, p < 0.001). The PROMISE minimal-risk tool improved discrimination compared with the CADC model (c-statistic 0.785 vs 0.730, p < 0.001) and was improved further following re-estimation of covariate coefficients (c-statistic 0.805, p < 0.001). Model calibration was initially poor (χ 2 197.6, Hosmer-Lemeshow [HL] p < 0.001), with significant overestimation of probability of minimal risk, but improved significantly following revision of the PROMISE minimal-risk intercept and covariate coefficients (χ 2 5.6, HL p = 0.692). Conclusion and relevance: Despite overestimating the probability of minimal-risk, the PROMISE minimal-risk tool outperforms the CADC model with regards to prognostic discrimination in patients with suspected stable angina, and may assist clinicians in decisions regarding non-invasive testing. Trial registration: ClinicalTrials.gov identifier:NCT01149590