Simon Winther

Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease: a prospective study with a fractional flow reserve endpoint

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Standard

Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease : a prospective study with a fractional flow reserve endpoint. / Winther, Simon; Nissen, Louise; Westra, Jelmer; Schmidt, Samuel Emil; Bouteldja, Nadia; Knudsen, Lars Lyhne; Madsen, Lene Helleskov; Frost, Lars; Urbonaviciene, Grazina; Holm, Niels Ramsing; Christiansen, Evald Høj; Bøtker, Hans Erik; Bøttcher, Morten.

In: European Heart Journal Cardiovascular Imaging, Vol. 20, No. 11, 11.2019, p. 1208-1218.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

APA

CBE

MLA

Vancouver

Author

Bibtex

@article{192d70fc52fa4770b238db31dcfde15c,
title = "Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease: a prospective study with a fractional flow reserve endpoint",
abstract = "AIMS: European and North American guidelines currently recommend pre-test probability (PTP) stratification based on simple probability models in patients with suspected coronary artery disease (CAD). However, no unequivocal recommendation has yet been established. We aimed to compare the ability of risk factors and different PTP stratification models to predict haemodynamically obstructive CAD with fractional flow reserve (FFR) as reference in low to intermediate probability patients. METHODS AND RESULTS: We prospectively included 1675 patients with low to intermediate risk who had been referred to coronary computed tomography angiography (CTA). Patients with coronary stenosis were subsequently investigated by invasive coronary angiography (ICA) with FFR measurement if indicated. Discrimination and calibration were assessed for four models: the updated Diamond-Forrester (UDF), the CAD Consortium Basic, the Clinical, and the Clinical + Coronary artery calcium score (CACS). At coronary CTA, 24% of patients were diagnosed with a suspected stenosis and 10% had haemodynamically obstructive CAD at the ICA. Calibration for all CAD Consortium models increased compared with the UDF score. However, all models overestimated the probability of haemodynamically obstructive CAD. Discrimination increased by area under the receiver operating curve from 67% to 86% for UDF vs. CAD Consortium Clinical + CACS. The proportion of low-probability patients (pre-test score < 15%) was for the UDF, CAD Consortium Basic, Clinical, and Clinical + CACS: 14%, 58%, 51%, and 66%, respectively. The corresponding negative predictive values were 97%, 94%, 95%, and 98%, respectively. CONCLUSION: CAD Consortium models improve PTP stratification compared with the UDF score, mainly due to superior calibration in low to intermediate probability patients. Adding the coronary calcium score to the models substantially increases discrimination. CLINICAL TRIALS. GOV IDENTIFIER: NCT02264717.",
keywords = "coronary angiography, coronary computed tomography angiography, fractional flow reserve, risk factors, risk stratification",
author = "Simon Winther and Louise Nissen and Jelmer Westra and Schmidt, {Samuel Emil} and Nadia Bouteldja and Knudsen, {Lars Lyhne} and Madsen, {Lene Helleskov} and Lars Frost and Grazina Urbonaviciene and Holm, {Niels Ramsing} and Christiansen, {Evald H{\o}j} and B{\o}tker, {Hans Erik} and Morten B{\o}ttcher",
note = "Published on behalf of the European Society of Cardiology. All rights reserved. {\textcopyright} The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.",
year = "2019",
month = nov,
doi = "10.1093/ehjci/jez058",
language = "English",
volume = "20",
pages = "1208--1218",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "1525-2167",
publisher = "Oxford University Press",
number = "11",

}

RIS

TY - JOUR

T1 - Pre-test probability prediction in patients with a low to intermediate probability of coronary artery disease

T2 - a prospective study with a fractional flow reserve endpoint

AU - Winther, Simon

AU - Nissen, Louise

AU - Westra, Jelmer

AU - Schmidt, Samuel Emil

AU - Bouteldja, Nadia

AU - Knudsen, Lars Lyhne

AU - Madsen, Lene Helleskov

AU - Frost, Lars

AU - Urbonaviciene, Grazina

AU - Holm, Niels Ramsing

AU - Christiansen, Evald Høj

AU - Bøtker, Hans Erik

AU - Bøttcher, Morten

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

PY - 2019/11

Y1 - 2019/11

N2 - AIMS: European and North American guidelines currently recommend pre-test probability (PTP) stratification based on simple probability models in patients with suspected coronary artery disease (CAD). However, no unequivocal recommendation has yet been established. We aimed to compare the ability of risk factors and different PTP stratification models to predict haemodynamically obstructive CAD with fractional flow reserve (FFR) as reference in low to intermediate probability patients. METHODS AND RESULTS: We prospectively included 1675 patients with low to intermediate risk who had been referred to coronary computed tomography angiography (CTA). Patients with coronary stenosis were subsequently investigated by invasive coronary angiography (ICA) with FFR measurement if indicated. Discrimination and calibration were assessed for four models: the updated Diamond-Forrester (UDF), the CAD Consortium Basic, the Clinical, and the Clinical + Coronary artery calcium score (CACS). At coronary CTA, 24% of patients were diagnosed with a suspected stenosis and 10% had haemodynamically obstructive CAD at the ICA. Calibration for all CAD Consortium models increased compared with the UDF score. However, all models overestimated the probability of haemodynamically obstructive CAD. Discrimination increased by area under the receiver operating curve from 67% to 86% for UDF vs. CAD Consortium Clinical + CACS. The proportion of low-probability patients (pre-test score < 15%) was for the UDF, CAD Consortium Basic, Clinical, and Clinical + CACS: 14%, 58%, 51%, and 66%, respectively. The corresponding negative predictive values were 97%, 94%, 95%, and 98%, respectively. CONCLUSION: CAD Consortium models improve PTP stratification compared with the UDF score, mainly due to superior calibration in low to intermediate probability patients. Adding the coronary calcium score to the models substantially increases discrimination. CLINICAL TRIALS. GOV IDENTIFIER: NCT02264717.

AB - AIMS: European and North American guidelines currently recommend pre-test probability (PTP) stratification based on simple probability models in patients with suspected coronary artery disease (CAD). However, no unequivocal recommendation has yet been established. We aimed to compare the ability of risk factors and different PTP stratification models to predict haemodynamically obstructive CAD with fractional flow reserve (FFR) as reference in low to intermediate probability patients. METHODS AND RESULTS: We prospectively included 1675 patients with low to intermediate risk who had been referred to coronary computed tomography angiography (CTA). Patients with coronary stenosis were subsequently investigated by invasive coronary angiography (ICA) with FFR measurement if indicated. Discrimination and calibration were assessed for four models: the updated Diamond-Forrester (UDF), the CAD Consortium Basic, the Clinical, and the Clinical + Coronary artery calcium score (CACS). At coronary CTA, 24% of patients were diagnosed with a suspected stenosis and 10% had haemodynamically obstructive CAD at the ICA. Calibration for all CAD Consortium models increased compared with the UDF score. However, all models overestimated the probability of haemodynamically obstructive CAD. Discrimination increased by area under the receiver operating curve from 67% to 86% for UDF vs. CAD Consortium Clinical + CACS. The proportion of low-probability patients (pre-test score < 15%) was for the UDF, CAD Consortium Basic, Clinical, and Clinical + CACS: 14%, 58%, 51%, and 66%, respectively. The corresponding negative predictive values were 97%, 94%, 95%, and 98%, respectively. CONCLUSION: CAD Consortium models improve PTP stratification compared with the UDF score, mainly due to superior calibration in low to intermediate probability patients. Adding the coronary calcium score to the models substantially increases discrimination. CLINICAL TRIALS. GOV IDENTIFIER: NCT02264717.

KW - coronary angiography

KW - coronary computed tomography angiography

KW - fractional flow reserve

KW - risk factors

KW - risk stratification

UR - http://www.scopus.com/inward/record.url?scp=85074003588&partnerID=8YFLogxK

U2 - 10.1093/ehjci/jez058

DO - 10.1093/ehjci/jez058

M3 - Journal article

C2 - 31083725

VL - 20

SP - 1208

EP - 1218

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 1525-2167

IS - 11

ER -