Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study

  1. Feger, Sarah
  2. Ibes, Paolo
  3. Napp, Adriane E.
  4. Lembcke, Alexander
  5. Laule, Michael
  6. Dreger, Henryk
  7. Bokelmann, Björn
  8. Davis, Gershan K.
  9. Roditi, Giles
  10. Diez, Ignacio
  11. Schröder, Stephen
  12. Plank, Fabian
  13. Maurovich-Horvat, Pal
  14. Vidakovic, Radosav
  15. Veselka, Josef
  16. Ilnicka-Suckiel, Malgorzata
  17. Erglis, Andrejs
  18. Benedek, Teodora
  19. Rodriguez-Palomares, José
  20. Saba, Luca
  21. Kofoed, Klaus F.
  22. Gutberlet, Matthias
  23. Ađić, Filip
  24. Pietilä, Mikko
  25. Faria, Rita
  26. Vaitiekiene, Audrone
  27. Dodd, Jonathan D.
  28. Donnelly, Patrick
  29. Francone, Marco
  30. Kepka, Cezary
  31. Ruzsics, Balazs
  32. Müller-Nordhorn, Jacqueline
  33. Schlattmann, Peter
  34. Dewey, Marc ORCID logo

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1000 Titel
  • Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study
1000 Autor/in
  1. Feger, Sarah |
  2. Ibes, Paolo |
  3. Napp, Adriane E. |
  4. Lembcke, Alexander |
  5. Laule, Michael |
  6. Dreger, Henryk |
  7. Bokelmann, Björn |
  8. Davis, Gershan K. |
  9. Roditi, Giles |
  10. Diez, Ignacio |
  11. Schröder, Stephen |
  12. Plank, Fabian |
  13. Maurovich-Horvat, Pal |
  14. Vidakovic, Radosav |
  15. Veselka, Josef |
  16. Ilnicka-Suckiel, Malgorzata |
  17. Erglis, Andrejs |
  18. Benedek, Teodora |
  19. Rodriguez-Palomares, José |
  20. Saba, Luca |
  21. Kofoed, Klaus F. |
  22. Gutberlet, Matthias |
  23. Ađić, Filip |
  24. Pietilä, Mikko |
  25. Faria, Rita |
  26. Vaitiekiene, Audrone |
  27. Dodd, Jonathan D. |
  28. Donnelly, Patrick |
  29. Francone, Marco |
  30. Kepka, Cezary |
  31. Ruzsics, Balazs |
  32. Müller-Nordhorn, Jacqueline |
  33. Schlattmann, Peter |
  34. Dewey, Marc |
1000 Erscheinungsjahr 2020
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2020-09-09
1000 Erschienen in
1000 Quellenangabe
  • 31(3):1471-1481
1000 Copyrightjahr
  • 2020
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1007/s00330-020-07175-z |
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880945/ |
1000 Publikationsstatus
1000 Begutachtungsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • 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.
1000 Sacherschließung
lokal Europe [MeSH]
lokal Female [MeSH]
lokal Patient Discharge [MeSH]
lokal Prevalence
lokal Probability of disease
lokal Coronary Stenosis/epidemiology [MeSH]
lokal Computed tomography angiography
lokal Risk Assessment [MeSH]
lokal Humans [MeSH]
lokal Predictive Value of Tests [MeSH]
lokal Risk Factors [MeSH]
lokal Coronary Stenosis/diagnostic imaging [MeSH]
lokal Coronary Artery Disease/epidemiology [MeSH]
lokal Male [MeSH]
lokal Computed Tomography Angiography [MeSH]
lokal Coronary Angiography [MeSH]
lokal Pilot Projects [MeSH]
lokal Coronary Artery Disease/diagnostic imaging [MeSH]
lokal Computed Tomography
lokal Coronary artery disease
1000 Liste der Beteiligten
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