Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model
Abstract Background Reliability of models for estimating pretest probability (PTP) of obstructive coronary artery disease (CAD) has not been investigated in individuals at low extreme of traditional risk factor (RF) burden. Thus, we sought to validate and compare CONFIRM score and Genders extended m...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12872-018-0912-3 |
| _version_ | 1818283234118598656 |
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| author | Minghui Wang Yujie Liu Xiujun Zhou Jia Zhou Hong Zhang Ying Zhang |
| author_facet | Minghui Wang Yujie Liu Xiujun Zhou Jia Zhou Hong Zhang Ying Zhang |
| author_sort | Minghui Wang |
| collection | DOAJ |
| description | Abstract Background Reliability of models for estimating pretest probability (PTP) of obstructive coronary artery disease (CAD) has not been investigated in individuals at low extreme of traditional risk factor (RF) burden. Thus, we sought to validate and compare CONFIRM score and Genders extended model (GEM) among these individuals. Methods We identified symptomatic individuals with 0 or 1 RF who underwent coronary calcium scan and coronary computed tomographic angiography (CCTA). Follow-up clinical data were also recorded. PTP of obstructive CAD for every individual was estimated according to CONFIRM score and GEM, respectively. Area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and Hosmer–Lemeshow (H-L) test were used to assess the performance of models. Results There were 1201 individuals with 0 RF and 2415 with 1 RF. The AUC for GEM was significantly larger than that for CONFIRM score, no matter in individuals with 0 (0.843 v.s. 0.762, p < 0.0001) or 1 (0.823 v.s. 0.752, p < 0.0001) RF. Compared to CONFIRM score, GEM demonstrated positive IDI (5% in individuals with 0 RF and 8% in individuals with 1 RF), positive NRI (41.50% in individuals with 0 RF and 40.19% in individuals with 1 RF), better prediction of clinical events and less discrepancy between observed and predicted probabilities, resulting in a significant decrease of unnecessary testing, especially in negative individuals. Conclusion In individuals at low extreme of traditional RF burden of CAD, the addition of coronary calcium score provided a more accurate estimation for PTP and application of GEM instead of CONFIRM score could avoid unnecessary testing. |
| first_indexed | 2024-12-13T00:33:40Z |
| format | Article |
| id | doaj.art-d0054a8c7a654d09b538015d6b3a28ad |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-13T00:33:40Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-d0054a8c7a654d09b538015d6b3a28ad2022-12-22T00:05:15ZengBMCBMC Cardiovascular Disorders1471-22612018-08-011811710.1186/s12872-018-0912-3Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended modelMinghui Wang0Yujie Liu1Xiujun Zhou2Jia Zhou3Hong Zhang4Ying Zhang5Department of Cardiology, Tianjin Chest HospitalDepartment of Cardiology, Tianjin Chest HospitalDepartment of Cardiology, Tianjin Chest HospitalDepartment of Cardiology, Tianjin Chest HospitalDepartment of Radiology, Tianjin Chest HospitalDepartment of Cardiology, Tianjin Chest HospitalAbstract Background Reliability of models for estimating pretest probability (PTP) of obstructive coronary artery disease (CAD) has not been investigated in individuals at low extreme of traditional risk factor (RF) burden. Thus, we sought to validate and compare CONFIRM score and Genders extended model (GEM) among these individuals. Methods We identified symptomatic individuals with 0 or 1 RF who underwent coronary calcium scan and coronary computed tomographic angiography (CCTA). Follow-up clinical data were also recorded. PTP of obstructive CAD for every individual was estimated according to CONFIRM score and GEM, respectively. Area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and Hosmer–Lemeshow (H-L) test were used to assess the performance of models. Results There were 1201 individuals with 0 RF and 2415 with 1 RF. The AUC for GEM was significantly larger than that for CONFIRM score, no matter in individuals with 0 (0.843 v.s. 0.762, p < 0.0001) or 1 (0.823 v.s. 0.752, p < 0.0001) RF. Compared to CONFIRM score, GEM demonstrated positive IDI (5% in individuals with 0 RF and 8% in individuals with 1 RF), positive NRI (41.50% in individuals with 0 RF and 40.19% in individuals with 1 RF), better prediction of clinical events and less discrepancy between observed and predicted probabilities, resulting in a significant decrease of unnecessary testing, especially in negative individuals. Conclusion In individuals at low extreme of traditional RF burden of CAD, the addition of coronary calcium score provided a more accurate estimation for PTP and application of GEM instead of CONFIRM score could avoid unnecessary testing.http://link.springer.com/article/10.1186/s12872-018-0912-3Coronary computed tomographic angiographyPretest probability of obstructive coronary artery diseaseLow extreme of risk factorCoronary calcium scoreUnnecessary testing |
| spellingShingle | Minghui Wang Yujie Liu Xiujun Zhou Jia Zhou Hong Zhang Ying Zhang Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model BMC Cardiovascular Disorders Coronary computed tomographic angiography Pretest probability of obstructive coronary artery disease Low extreme of risk factor Coronary calcium score Unnecessary testing |
| title | Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model |
| title_full | Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model |
| title_fullStr | Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model |
| title_full_unstemmed | Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model |
| title_short | Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model |
| title_sort | coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden validation and comparison of confirm score and genders extended model |
| topic | Coronary computed tomographic angiography Pretest probability of obstructive coronary artery disease Low extreme of risk factor Coronary calcium score Unnecessary testing |
| url | http://link.springer.com/article/10.1186/s12872-018-0912-3 |
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