Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain

Laust Dupont Rasmussen; Salma Raghad Karim; Jelmer Westra; Louise Nissen; Jonathan Nørtoft Dahl; Gitte Stokvad Brix; Juhani Knuuti; Samuel Emil Schmidt; Niels Ramsing Holm; Evald Høj Christiansen; Ashkan Eftekhari; Morten Bøttcher; Simon Winther

doi:10.1016/j.jcmg.2024.04.015

Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain

Laust Dupont Rasmussen^*, Salma Raghad Karim, Jelmer Westra, Louise Nissen, Jonathan Nørtoft Dahl, Gitte Stokvad Brix, Juhani Knuuti, Samuel Emil Schmidt, Niels Ramsing Holm, Evald Høj Christiansen, Ashkan Eftekhari, Morten Bøttcher, Simon Winther

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

3 Citationer (Scopus)

Abstract

Background: Selection for invasive angiography is recommended to be based on pretest probabilities (PTPs), and physiological measures of hemodynamical impairment by, for example, fractional flow reserve (FFR) should guide revascularization. The risk factor–weighted clinical likelihood (RF-CL) and coronary artery calcium score–weighted clinical likelihood (CACS-CL) models show superior discrimination of patients with suspected obstructive coronary artery disease (CAD), but validation against hemodynamic impairment is warranted. Objectives: The aim of this study was to validate the RF-CL and CACS-CL models against hemodynamically obstructive CAD. Methods: Stable de novo chest pain patients (N = 4,371) underwent coronary computed tomography angiography and subsequently invasive coronary angiography with FFR measurements. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or high-grade stenosis by visual assessment (>90% diameter stenosis). For comparison, a guideline-endorsed basic PTP model was calculated based on age, sex, and symptom typicality. The RF-CL model additionally included the number of risk factors, and the CACS-CL model incorporated the coronary artery calcium score into the RF-CL. Results: In total, 447 of 4,371 (10.9%) patients had hemodynamically obstructive CAD. Both the RF-CL and CACS-CL models classified more patients with a very low clinical likelihood (≤5%) of obstructive CAD compared to the basic PTP model (33.0% and 53.7% vs 12.0%; P < 0.001) with a preserved low prevalence of hemodynamically obstructive CAD (<5% for all models). Against hemodynamically obstructive CAD, calibration and discrimination of the RF-CL and CACS-CL models were superior to the basic PTP model. Conclusions: The RF-CL and CACS-CL models are well calibrated and superior to a currently recommended basic PTP model to predict hemodynamically obstructive CAD.

Originalsprog	Engelsk
Tidsskrift	JACC: Cardiovascular Imaging
Vol/bind	17
Nummer	10
Sider (fra-til)	1199-1210
Antal sider	12
ISSN	1936-878X
DOI	https://doi.org/10.1016/j.jcmg.2024.04.015
Status	Udgivet - okt. 2024

Adgang til dokumentet

10.1016/j.jcmg.2024.04.015

Andre filer og links

Link to publication in Scopus

Citationsformater

Rasmussen, L. D., Karim, S. R., Westra, J., Nissen, L., Dahl, J. N., Brix, G. S., Knuuti, J., Schmidt, S. E., Holm, N. R., Christiansen, E. H., Eftekhari, A., Bøttcher, M., & Winther, S. (2024). Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain. JACC: Cardiovascular Imaging, 17(10), 1199-1210. https://doi.org/10.1016/j.jcmg.2024.04.015

@article{c6e08038ec334d50b1b9e70a319f102a,

title = "Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain",

abstract = "Background: Selection for invasive angiography is recommended to be based on pretest probabilities (PTPs), and physiological measures of hemodynamical impairment by, for example, fractional flow reserve (FFR) should guide revascularization. The risk factor–weighted clinical likelihood (RF-CL) and coronary artery calcium score–weighted clinical likelihood (CACS-CL) models show superior discrimination of patients with suspected obstructive coronary artery disease (CAD), but validation against hemodynamic impairment is warranted. Objectives: The aim of this study was to validate the RF-CL and CACS-CL models against hemodynamically obstructive CAD. Methods: Stable de novo chest pain patients (N = 4,371) underwent coronary computed tomography angiography and subsequently invasive coronary angiography with FFR measurements. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or high-grade stenosis by visual assessment (>90% diameter stenosis). For comparison, a guideline-endorsed basic PTP model was calculated based on age, sex, and symptom typicality. The RF-CL model additionally included the number of risk factors, and the CACS-CL model incorporated the coronary artery calcium score into the RF-CL. Results: In total, 447 of 4,371 (10.9%) patients had hemodynamically obstructive CAD. Both the RF-CL and CACS-CL models classified more patients with a very low clinical likelihood (≤5%) of obstructive CAD compared to the basic PTP model (33.0% and 53.7% vs 12.0%; P < 0.001) with a preserved low prevalence of hemodynamically obstructive CAD (<5% for all models). Against hemodynamically obstructive CAD, calibration and discrimination of the RF-CL and CACS-CL models were superior to the basic PTP model. Conclusions: The RF-CL and CACS-CL models are well calibrated and superior to a currently recommended basic PTP model to predict hemodynamically obstructive CAD.",

keywords = "chronic coronary syndrome, clinical likelihood, coronary artery disease, invasive fractional flow reserve, pretest probability",

author = "Rasmussen, {Laust Dupont} and Karim, {Salma Raghad} and Jelmer Westra and Louise Nissen and Dahl, {Jonathan N{\o}rtoft} and Brix, {Gitte Stokvad} and Juhani Knuuti and Schmidt, {Samuel Emil} and Holm, {Niels Ramsing} and Christiansen, {Evald H{\o}j} and Ashkan Eftekhari and Morten B{\o}ttcher and Simon Winther",

year = "2024",

month = oct,

doi = "10.1016/j.jcmg.2024.04.015",

language = "English",

volume = "17",

pages = "1199--1210",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "10",

}

Rasmussen, LD , Karim, SR , Westra, J , Nissen, L , Dahl, JN , Brix, GS, Knuuti, J, Schmidt, SE, Holm, NR , Christiansen, EH, Eftekhari, A, Bøttcher, M & Winther, S 2024, 'Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain', JACC: Cardiovascular Imaging, bind 17, nr. 10, s. 1199-1210. https://doi.org/10.1016/j.jcmg.2024.04.015

Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain. / Rasmussen, Laust Dupont ; Karim, Salma Raghad ; Westra, Jelmer et al.
I: JACC: Cardiovascular Imaging, Bind 17, Nr. 10, 10.2024, s. 1199-1210.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain

AU - Rasmussen, Laust Dupont

AU - Karim, Salma Raghad

AU - Westra, Jelmer

AU - Nissen, Louise

AU - Dahl, Jonathan Nørtoft

AU - Brix, Gitte Stokvad

AU - Knuuti, Juhani

AU - Schmidt, Samuel Emil

AU - Holm, Niels Ramsing

AU - Christiansen, Evald Høj

AU - Eftekhari, Ashkan

AU - Bøttcher, Morten

AU - Winther, Simon

PY - 2024/10

Y1 - 2024/10

N2 - Background: Selection for invasive angiography is recommended to be based on pretest probabilities (PTPs), and physiological measures of hemodynamical impairment by, for example, fractional flow reserve (FFR) should guide revascularization. The risk factor–weighted clinical likelihood (RF-CL) and coronary artery calcium score–weighted clinical likelihood (CACS-CL) models show superior discrimination of patients with suspected obstructive coronary artery disease (CAD), but validation against hemodynamic impairment is warranted. Objectives: The aim of this study was to validate the RF-CL and CACS-CL models against hemodynamically obstructive CAD. Methods: Stable de novo chest pain patients (N = 4,371) underwent coronary computed tomography angiography and subsequently invasive coronary angiography with FFR measurements. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or high-grade stenosis by visual assessment (>90% diameter stenosis). For comparison, a guideline-endorsed basic PTP model was calculated based on age, sex, and symptom typicality. The RF-CL model additionally included the number of risk factors, and the CACS-CL model incorporated the coronary artery calcium score into the RF-CL. Results: In total, 447 of 4,371 (10.9%) patients had hemodynamically obstructive CAD. Both the RF-CL and CACS-CL models classified more patients with a very low clinical likelihood (≤5%) of obstructive CAD compared to the basic PTP model (33.0% and 53.7% vs 12.0%; P < 0.001) with a preserved low prevalence of hemodynamically obstructive CAD (<5% for all models). Against hemodynamically obstructive CAD, calibration and discrimination of the RF-CL and CACS-CL models were superior to the basic PTP model. Conclusions: The RF-CL and CACS-CL models are well calibrated and superior to a currently recommended basic PTP model to predict hemodynamically obstructive CAD.

AB - Background: Selection for invasive angiography is recommended to be based on pretest probabilities (PTPs), and physiological measures of hemodynamical impairment by, for example, fractional flow reserve (FFR) should guide revascularization. The risk factor–weighted clinical likelihood (RF-CL) and coronary artery calcium score–weighted clinical likelihood (CACS-CL) models show superior discrimination of patients with suspected obstructive coronary artery disease (CAD), but validation against hemodynamic impairment is warranted. Objectives: The aim of this study was to validate the RF-CL and CACS-CL models against hemodynamically obstructive CAD. Methods: Stable de novo chest pain patients (N = 4,371) underwent coronary computed tomography angiography and subsequently invasive coronary angiography with FFR measurements. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or high-grade stenosis by visual assessment (>90% diameter stenosis). For comparison, a guideline-endorsed basic PTP model was calculated based on age, sex, and symptom typicality. The RF-CL model additionally included the number of risk factors, and the CACS-CL model incorporated the coronary artery calcium score into the RF-CL. Results: In total, 447 of 4,371 (10.9%) patients had hemodynamically obstructive CAD. Both the RF-CL and CACS-CL models classified more patients with a very low clinical likelihood (≤5%) of obstructive CAD compared to the basic PTP model (33.0% and 53.7% vs 12.0%; P < 0.001) with a preserved low prevalence of hemodynamically obstructive CAD (<5% for all models). Against hemodynamically obstructive CAD, calibration and discrimination of the RF-CL and CACS-CL models were superior to the basic PTP model. Conclusions: The RF-CL and CACS-CL models are well calibrated and superior to a currently recommended basic PTP model to predict hemodynamically obstructive CAD.

KW - chronic coronary syndrome

KW - clinical likelihood

KW - coronary artery disease

KW - invasive fractional flow reserve

KW - pretest probability

UR - http://www.scopus.com/inward/record.url?scp=85199200165&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2024.04.015

DO - 10.1016/j.jcmg.2024.04.015

M3 - Journal article

C2 - 38970593

SN - 1936-878X

VL - 17

SP - 1199

EP - 1210

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 10

ER -

Clinical Likelihood Prediction of Hemodynamically Obstructive Coronary Artery Disease in Patients With Stable Chest Pain

Abstract

Adgang til dokumentet

Andre filer og links

Fingeraftryk

Citationsformater