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Diagnostic performance of clinical likelihood models of obstructive coronary artery disease to predict myocardial perfusion defects

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review


  • Laust Dupont Rasmussen
  • Line Emilie Brøgger Albertsen, Regionshospitalet Gødstrup
  • ,
  • Louise Nissen
  • June Anita Ejlersen
  • Christin Isaksen, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways
  • ,
  • Theodore Murphy, St Bartholomew's Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom.
  • ,
  • Hanne Maare Søndergaard
  • Jane Kirk, e Department of Pathology , Regional Hospital Central Jutland , Viborg , Denmark.
  • ,
  • Lau Brix
  • Lars Christian Gormsen
  • Steffen E Petersen, Barts Heart Centre, St Bartholomew's Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom., Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London NIHR Biomedical Research Unit, the London Chest Hospital, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom., Queen Mary Univ London, University of London, Queen Mary University London, World Health Organization, Blizard Inst, WHO Collaborating Ctr Mental Hlth Serv Dev, Unit Social & Community Psychiat,NCfMH
  • ,
  • Morten Bøttcher
  • Simon Winther

AIMS: Clinical likelihood (CL) models are designed based on a reference of coronary stenosis in patients with suspected obstructive coronary artery disease (CAD). However, a reference standard of a myocardial perfusion defects (MPD) could be more appropriate.We aimed to investigate the ability of the 2019 European Society of Cardiology pre-test probability (ESC-PTP), the risk factor-weighted (RF-CL) and coronary artery calcium score-weighted (CACS-CL) models to diagnose MPDs.

METHODS AND RESULTS: Symptomatic stable de novo chest pain patients (n = 3374) underwent coronary computed tomography angiography (CTA) and subsequent myocardial perfusion imaging by single photon emission tomography (SPECT), positron emission tomography (PET) or cardiac magnetic resonance (CMR). For all modalities, MPD was defined as coronary CTA with suspected stenosis and stress-perfusion abnormality in ≥2 segments. The ESC-PTP was calculated based on age, sex and symptom typicality, and the RF-CL and CACS-CL additionally included a number of risk factors and CACS.In total, 219/3374 (6.5%) patients had a MPD. Both the RF-CL and CACS-CL classified substantially more patients to low CL (<5%) of obstructive CAD compared to the ESC-PTP (32.5% and 54.1% vs. 12.0%, p < 0.001) with preserved low prevalences of MPD (<2% for all models). Compared to the ESC-PTP (AUC 0.74 (0.71-0.78), the discrimination of having a MPD was higher for the CACS-CL (AUC 0.88 (0.86-0.91), p < 0.001) while similar for the RF-CL model (AUC 0.73 (0.70-0.76), p = 0.32).

CONCLUSIONS: Compared to basic CL models, the RF-CL and CACS-CL models improve down-classification of patients to a very low-risk group with low prevalence of MPD.

TidsskriftEuropean Heart Journal Cardiovascular Imaging
StatusE-pub ahead of print - 7 jun. 2023

Bibliografisk note

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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