Validation of the European Society of Cardiology pre-test probability model for obstructive coronary artery disease. (12th November 2020)

• Record Type: Journal Article
• Authors: Winther, Simon; Schmidt, Samuel Emil; Rasmussen, Laust Dupont; Juárez Orozco, Luis Eduardo; Steffensen, Flemming Hald; Bøtker, Hans Erik; Knuuti, Juhani; Bøttcher, Morten
• Is Part Of: European heart journal. Volume 42:Number 14(2021)
• Page Start: 1401
• Page End: 1411
• Publication Date: 2020-11-12
• Subjects: Coronary artery disease -- Stable coronary artery disease -- Chronic coronary syndrome -- Pre-test probability -- Coronary stenosis -- Computed tomography angiography; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehaa755
• Languages: English
• ISSNs: 0195-668X

Abstract

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.