Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease
Background Substantial differences exist between different guideline‐recommended pretest probability (PTP) models for the detection of obstructive coronary artery disease (CAD). This study was performed to study the performance of the 2021 American Heart Association/American College of Cardiology (A...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027260 |
| _version_ | 1811170054410076160 |
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| author | Simon Winther Theodore Murphy Samuel Emil Schmidt Jeroen J. Bax William Wijns Juhani Knuuti Morten Bøttcher |
| author_facet | Simon Winther Theodore Murphy Samuel Emil Schmidt Jeroen J. Bax William Wijns Juhani Knuuti Morten Bøttcher |
| author_sort | Simon Winther |
| collection | DOAJ |
| description | Background Substantial differences exist between different guideline‐recommended pretest probability (PTP) models for the detection of obstructive coronary artery disease (CAD). This study was performed to study the performance of the 2021 American Heart Association/American College of Cardiology (AHA/ACC) guideline‐recommended PTP (AHA/ACC‐PTP) model in assessing the likelihood of obstructive CAD compared with previously proposed models. Methods and Results Symptomatic patients (N=50 561) referred for coronary computed tomography angiography were included. The reference standard was invasive coronary angiography with optional fractional flow reserve measurements. The AHA/ACC‐PTP values based on sex and age were calculated and compared with the 2019 European Society of Cardiology guideline PTP values based on sex, age, and symptoms as well as the risk factor–weighted clinical likelihood values based on sex, age, symptoms, and risk factors. The AHA/ACC‐PTP maximum values overestimated by a factor of 2.6 the actual prevalence of CAD. Compared with the AHA/ACC‐PTP model (area under the receiver‐operating curve, 71.5 [95% CI, 70.7–72.2]), inclusion of typicality of symptoms in the European Society of Cardiology guideline PTP improved discrimination of CAD (area under the receiver‐operating curve, 75.5 [95% CI, 74.7–76.3]). Inclusion of both symptoms and risk factors in the risk factor–weighted clinical likelihood model further improved discrimination (area under the receiver‐operating curve, 77.7 [95% CI, 77.0–78.5]). The proportion of patients classified as very low PTP was lower using the AHA/ACC‐PTP (5%) compared with the European Society of Cardiology guideline PTP (19%) and the risk factor–weighted clinical likelihood (49%) models. Conclusions The new AHA/ACC‐PTP model overestimates the prevalence of obstructive CAD substantially if type of symptoms and risk factors are not taken into account. Inclusion of both symptoms and risk factors improves model performance and identifies more patients with very low likelihood of CAD in whom further testing can be deferred. |
| first_indexed | 2024-04-10T16:51:12Z |
| format | Article |
| id | doaj.art-b1cea6c53f5b455bbce65668948a07b7 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T16:51:12Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-b1cea6c53f5b455bbce65668948a07b72023-02-07T16:03:49ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-12-01112410.1161/JAHA.122.027260Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery DiseaseSimon Winther0Theodore Murphy1Samuel Emil Schmidt2Jeroen J. Bax3William Wijns4Juhani Knuuti5Morten Bøttcher6Department of Cardiology Gødstrup Hospital Herning DenmarkBarts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust London United KingdomDepartment of Health Science and Technology Aalborg University Aalborg Øst DenmarkHeart Center Turku University Hsopital and University of Turku Turku FinlandThe Lambe Institute for Translational Medicine and Curam National University of Ireland Galway IrelandTurku PET Centre Turku University Hospital and University of Turku Turku FinlandDepartment of Cardiology Gødstrup Hospital Herning DenmarkBackground Substantial differences exist between different guideline‐recommended pretest probability (PTP) models for the detection of obstructive coronary artery disease (CAD). This study was performed to study the performance of the 2021 American Heart Association/American College of Cardiology (AHA/ACC) guideline‐recommended PTP (AHA/ACC‐PTP) model in assessing the likelihood of obstructive CAD compared with previously proposed models. Methods and Results Symptomatic patients (N=50 561) referred for coronary computed tomography angiography were included. The reference standard was invasive coronary angiography with optional fractional flow reserve measurements. The AHA/ACC‐PTP values based on sex and age were calculated and compared with the 2019 European Society of Cardiology guideline PTP values based on sex, age, and symptoms as well as the risk factor–weighted clinical likelihood values based on sex, age, symptoms, and risk factors. The AHA/ACC‐PTP maximum values overestimated by a factor of 2.6 the actual prevalence of CAD. Compared with the AHA/ACC‐PTP model (area under the receiver‐operating curve, 71.5 [95% CI, 70.7–72.2]), inclusion of typicality of symptoms in the European Society of Cardiology guideline PTP improved discrimination of CAD (area under the receiver‐operating curve, 75.5 [95% CI, 74.7–76.3]). Inclusion of both symptoms and risk factors in the risk factor–weighted clinical likelihood model further improved discrimination (area under the receiver‐operating curve, 77.7 [95% CI, 77.0–78.5]). The proportion of patients classified as very low PTP was lower using the AHA/ACC‐PTP (5%) compared with the European Society of Cardiology guideline PTP (19%) and the risk factor–weighted clinical likelihood (49%) models. Conclusions The new AHA/ACC‐PTP model overestimates the prevalence of obstructive CAD substantially if type of symptoms and risk factors are not taken into account. Inclusion of both symptoms and risk factors improves model performance and identifies more patients with very low likelihood of CAD in whom further testing can be deferred.https://www.ahajournals.org/doi/10.1161/JAHA.122.027260chronic coronary syndromecomputed tomography angiographycoronary artery diseasecoronary stenosispretest probabilitystable coronary artery disease |
| spellingShingle | Simon Winther Theodore Murphy Samuel Emil Schmidt Jeroen J. Bax William Wijns Juhani Knuuti Morten Bøttcher Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease chronic coronary syndrome computed tomography angiography coronary artery disease coronary stenosis pretest probability stable coronary artery disease |
| title | Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease |
| title_full | Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease |
| title_fullStr | Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease |
| title_full_unstemmed | Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease |
| title_short | Performance of the American Heart Association/American College of Cardiology Guideline‐Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease |
| title_sort | performance of the american heart association american college of cardiology guideline recommended pretest probability model for the diagnosis of obstructive coronary artery disease |
| topic | chronic coronary syndrome computed tomography angiography coronary artery disease coronary stenosis pretest probability stable coronary artery disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027260 |
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