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Tytuł:
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Comparison of guidelines for diagnosing suspected stable angina and the additional value of the calcium score.
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Autorzy:
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Rijlaarsdam-Hermsen D; Haaglanden Medical Center Bronovo, Department of Cardiology, The Hague, the Netherlands; Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands. Electronic address: .
van Domburg RT; Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands.
Deckers JW; Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands.
Kuijpers D; Haaglanden Medical Center Bronovo, Department of Radiology, The Hague, the Netherlands.
van Dijkman PRM; Haaglanden Medical Center Bronovo, Department of Cardiology, The Hague, the Netherlands; Leiden University Medical Center, Department of Cardiology, the Netherlands.
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Źródło:
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International journal of cardiology [Int J Cardiol] 2021 Dec 01; Vol. 344, pp. 1-7. Date of Electronic Publication: 2021 Sep 21.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: Amsterdam : Elsevier
Original Publication: Amsterdam : Elsevier/North-Holland Biomedical Press, c1981-
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MeSH Terms:
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Angina, Stable*/diagnostic imaging
Angina, Stable*/epidemiology
Coronary Artery Disease*/diagnostic imaging
Coronary Artery Disease*/epidemiology
Calcium ; Coronary Angiography ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Risk Factors ; United States
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Contributed Indexing:
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Keywords: Clinical guidelines; Coronary artery calcium score; Coronary artery disease; Pre-test likelihood; Stable angina
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Substance Nomenclature:
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SY7Q814VUP (Calcium)
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Entry Date(s):
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Date Created: 20210923 Date Completed: 20211108 Latest Revision: 20211108
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Update Code:
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20240105
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DOI:
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10.1016/j.ijcard.2021.09.039
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PMID:
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34555447
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Background The performance of current diagnostic algorithms of the American College of Cardiology/American Heart Association (ACC/AHA), National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) in patients with stable chest pain and coronary artery calcium (CAC) remains a matter of debate. We compared their merits in patients with CAC and investigated the additional value of the CAC score to improve diagnostic accuracy and risk stratification. Methods and results Patient data were obtained from a prospective registry of 642 consecutive patients. Mean age 63 (SD 11) years, 50% male. According to the guidelines, low and intermediate/high pre-test probability groups were constructed. Patients were reclassified based on their CAC score. Obstructive coronary artery disease (CAD) was observed in 14%. All models performed modestly in accurately predicting CAD (c-statistic <0.65). After addition of the CAC score, the c-statistic of the NICE model increased to 0.75 (95% confidence interval (CI) 0.73-0.78) which was just non-significant compared to the ESC model (0.71 95% CI 0.67-0.74) and performed significantly better than ACC/AHA (0.68 (95% CI 0.64-0.72)). After reclassification more than 50% of patients were classified low risk in NICE and ESC, while the prevalence of obstructive CAD (4.8% and 5.2% respectively) did not increase. Conclusions Addition of the CAC score to the studied models improved the ability to safely rule-out obstructive CAD and identified other patients at high risk for future coronary artery events. These results suggest that incorporating CAC score will lead to substantially less downstream testing and lower costs.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
