Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forresterfor the contemporary era and clinical implications: insights from the PROMISE trial
Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forresterfor the contemporary era and clinical implications: insights from the PROMISE trial
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DOI：
10.1093/ehjci/jey182
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发表时间：
2019-05-01
影响因子：
6.2
通讯作者：
Hoffmann, Udo
中科院分区：
文献类型：
--
作者：
Foldyna, Borek;Udelson, James E.;Hoffmann, Udo
目的利用冠状动脉CT血管成像(CTA)技术，在大量无创检测的稳定性胸痛患者中更新阻塞性冠状动脉疾病(CAD>；=50%)跨年龄、性别和临床症状层级的预测概率(PTP)。方法和结果：我们纳入了参加前瞻性多中心影像研究以评估胸痛的患者，并随机分为CTA组。专门获得III级认证的读者，对人口统计学和临床数据视而不见，在中央核心实验室评估CAD>；=50%的患病率。在比较了最近的欧洲心脏病学会-钻石和Forrester PTP(ESC-DF)和实际观察到的CAD和GT；=50%的患病率后，我们创建了一个新的PTP集合，用年龄、性别和心绞痛类型的观察到的CAD>；=50%的患病率取代ESC-DF PTP。在4415名患者(男性48.3%；60.5+/-8.2岁；不典型心绞痛78%；典型心绞痛11%；非心绞痛性胸痛11%)中，观察到的CAD>；=50%的患病率为13.9%，仅为ESC-DF PTP平均值(40.6%；P=50%)的三分之一。根据非侵入性测试结果得出的一套新的PTP可能会大大减少对稳定性胸痛进行非侵入性测试的需要。
Aims To update pretest probabilities (PTP) for obstructive coronary artery disease (CAD >= 50%) across age, sex, and clinical symptom strata, using coronary computed tomography angiography (CTA) in a large contemporary population of patients with stable chest pain referred to non-invasive testing.Methods and results We included patients enrolled in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial and randomized to CTA. Exclusively level III-certified readers, blinded to demographic and clinical data, assessed the prevalence of CAD >= 50% in a central core lab. After comparing the recent European Society of Cardiology-Diamond and Forrester PTP (ESC-DF) with the actual observed prevalence of CAD >= 50%, we created a new PTP set by replacing the ESC-DF PTP with the observed prevalence of CAD >= 50% across strata of age, sex, and type of angina. In 4415 patients (48.3% men; 60.5 +/- 8.2 years; 78% atypical angina; 11% typical angina; 11% non-anginal chest pain), the observed prevalence of CAD >= 50% was 13.9%, only one-third of the average ESC-DF PTP (40.6; P= 50%. A new set of PTP, derived from results of non-invasive testing, may substantially reduce the need for non-invasive tests in stable chest pain.