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

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Harvard

Feger, S, Ibes, P, Napp, AE, Lembcke, A, Laule, M, Dreger, H, Bokelmann, B, Davis, GK, Roditi, G, Diez, I, Schröder, S, Plank, F, Maurovich-Horvat, P, Vidakovic, R, Veselka, J, Ilnicka-Suckiel, M, Erglis, A, Benedek, T, Rodriguez-Palomares, J, Saba, L, Kofoed, KF, Gutberlet, M, Ađić, F, Pietilä, M, Faria, R, Vaitiekiene, A, Dodd, JD, Donnelly, P, Francone, M, Kepka, C, Ruzsics, B, Müller-Nordhorn, J, Schlattmann, P & Dewey, M 2021, 'Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study', European Radiology, bind 31, nr. 3, s. 1471-1481. https://doi.org/10.1007/s00330-020-07175-z

APA

Feger, S., Ibes, P., Napp, A. E., Lembcke, A., Laule, M., Dreger, H., Bokelmann, B., Davis, G. K., Roditi, G., Diez, I., Schröder, S., Plank, F., Maurovich-Horvat, P., Vidakovic, R., Veselka, J., Ilnicka-Suckiel, M., Erglis, A., Benedek, T., Rodriguez-Palomares, J., ... Dewey, M. (2021). Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study. European Radiology, 31(3), 1471-1481. https://doi.org/10.1007/s00330-020-07175-z

CBE

Feger S, Ibes P, Napp AE, Lembcke A, Laule M, Dreger H, Bokelmann B, Davis GK, Roditi G, Diez I, Schröder S, Plank F, Maurovich-Horvat P, Vidakovic R, Veselka J, Ilnicka-Suckiel M, Erglis A, Benedek T, Rodriguez-Palomares J, Saba L, Kofoed KF, Gutberlet M, Ađić F, Pietilä M, Faria R, Vaitiekiene A, Dodd JD, Donnelly P, Francone M, Kepka C, Ruzsics B, Müller-Nordhorn J, Schlattmann P, Dewey M. 2021. Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study. European Radiology. 31(3):1471-1481. https://doi.org/10.1007/s00330-020-07175-z

MLA

Vancouver

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. / Clinical pre-test probability for obstructive coronary artery disease : insights from the European DISCHARGE pilot study. I: European Radiology. 2021 ; Bind 31, Nr. 3. s. 1471-1481.

Bibtex

@article{1dfb07c9883e48ee8e710cdab389ddf1,
title = "Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study",
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.",
keywords = "Computed tomography angiography, Coronary artery disease, Prevalence, Probability of disease",
author = "Sarah Feger and Paolo Ibes and Napp, {Adriane E} and Alexander Lembcke and Michael Laule and Henryk Dreger and Bj{\"o}rn Bokelmann and Davis, {Gershan K} and Giles Roditi and Ignacio Diez and Stephen Schr{\"o}der and Fabian Plank and Pal Maurovich-Horvat and Radosav Vidakovic and Josef Veselka and Malgorzata Ilnicka-Suckiel and Andrejs Erglis and Teodora Benedek and Jos{\'e} Rodriguez-Palomares and Luca Saba and Kofoed, {Klaus F} and Matthias Gutberlet and Filip A{\d}i{\'c} and Mikko Pietil{\"a} and Rita Faria and Audrone Vaitiekiene and Dodd, {Jonathan D} and Patrick Donnelly and Marco Francone and Cezary Kepka and Balazs Ruzsics and Jacqueline M{\"u}ller-Nordhorn and Peter Schlattmann and Marc Dewey",
year = "2021",
month = mar,
doi = "10.1007/s00330-020-07175-z",
language = "English",
volume = "31",
pages = "1471--1481",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer",
number = "3",

}

RIS

TY - JOUR

T1 - Clinical pre-test probability for obstructive coronary artery disease

T2 - insights from the European DISCHARGE pilot study

AU - Feger, Sarah

AU - Ibes, Paolo

AU - Napp, Adriane E

AU - Lembcke, Alexander

AU - Laule, Michael

AU - Dreger, Henryk

AU - Bokelmann, Björn

AU - Davis, Gershan K

AU - Roditi, Giles

AU - Diez, Ignacio

AU - Schröder, Stephen

AU - Plank, Fabian

AU - Maurovich-Horvat, Pal

AU - Vidakovic, Radosav

AU - Veselka, Josef

AU - Ilnicka-Suckiel, Malgorzata

AU - Erglis, Andrejs

AU - Benedek, Teodora

AU - Rodriguez-Palomares, José

AU - Saba, Luca

AU - Kofoed, Klaus F

AU - Gutberlet, Matthias

AU - Ađić, Filip

AU - Pietilä, Mikko

AU - Faria, Rita

AU - Vaitiekiene, Audrone

AU - Dodd, Jonathan D

AU - Donnelly, Patrick

AU - Francone, Marco

AU - Kepka, Cezary

AU - Ruzsics, Balazs

AU - Müller-Nordhorn, Jacqueline

AU - Schlattmann, Peter

AU - Dewey, Marc

PY - 2021/3

Y1 - 2021/3

N2 - 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.

AB - 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.

KW - Computed tomography angiography

KW - Coronary artery disease

KW - Prevalence

KW - Probability of disease

U2 - 10.1007/s00330-020-07175-z

DO - 10.1007/s00330-020-07175-z

M3 - Journal article

C2 - 32902743

VL - 31

SP - 1471

EP - 1481

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 3

ER -

ID: 61811511