Coronary Calcium Scoring Improves Risk Prediction in Patients With Suspected Obstructive Coronary Artery Disease.
Coronary Calcium Scoring Improves Risk Prediction in Patients With Suspected Obstructive Coronary Artery Disease.
复制标题
冠状动脉钙评分可改善疑似阻塞性冠状动脉疾病患者的风险预测。
DOI：
10.1016/j.jacc.2022.08.805
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发表时间：
2022-11-22
影响因子：
24
通讯作者：
Bottcher, Morten
中科院分区：
文献类型：
--
作者：
Winther, Simon;Schmidt, Samuel E.;Foldyna, Borek;Mayrhofer, Thomas;Rasmussen, Laust D.;Dahl, Jonathan N.;Hoffmann, Udo;Douglas, Pamela S.;Knuuti, Juhani;Bottcher, Morten
关键词：
In patients suspect of obstructive coronary artery disease (CAD), the risk factors-weighted clinical likelihood (RF-CL) model and the coronary artery calcium score-weighted clinical likelihood (CACS-CL) model improves the identification of obstructive CAD as compared to basic pre-test probability (PTP) models. The aim of this study was to assess the prognostic value of the new models. The incidence of myocardial infarction and death were stratified according to categories by the RF-CL and CACS-CL and compared to categories by the PTP model. We used cohorts from a Danish register (n=41,177) and a North American randomized study (n=3,952). All patients were symptomatic and referred for diagnostic testing due to clinical indications. Despite substantial down-reclassification of patients to a likelihood ≤5% of CAD with either the RF-CL (45%) or CACS-CL (60%) models compared to the PTP (18%), the annualized event rates of myocardial infarction and death were low using all three models; RF-CL 0.51 (0.46–0.56), CACS-CL 0.48 (0.44–0.56) and PTP 0.37 (0.31–0.44), respectively. Overall, comparison of the predictive power of the three models using Harrell′s C-statistics demonstrated superiority of the RF-CL (0.64 (0.63–0.65)) and CACS-CL (0.69 (0.67–0.70)) as compared to the PTP model (0.61 (0.60–0.62)). The simple clinical likelihood models which include classical risk factors or risk factors combined with CACS provide improved risk stratification for myocardial infarction and death compared to the standard PTP model. Hence, the optimized RF-CL and CACS-CL models identifies 2.5 and 3.3 time more patients, respectively, who may not benefit from further diagnostic testing. In patients with suspected obstructive coronary artery disease (CAD), we aimed to assess the prognostic value of a new tool developed to estimate the clinical likelihood of obstructive CAD; the risk factor-weighted clinical likelihood (RF-CL) and the coronary artery calcium score -weighted clinical likelihood (CACS-CL) models. The RF-CL and CACS-CL models identified 27% and 42% more patients as having very low probability of CAD compared to the guideline endorsed basic pre-test probability model. Patients classified to very low probability using all three models had very low annualized event rates of myocardial infarction and death of ≤0.5%.
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影响因子：
158.5
作者：
Maron, David J.;Hochman, Judith S.;Rosenberg, Yves
通讯作者：
Rosenberg, Yves
影响因子：
6.2
作者：
Foldyna, Borek;Udelson, James E.;Hoffmann, Udo
通讯作者：
Hoffmann, Udo
影响因子：
39.3
作者：
Winther, Simon;Schmidt, Samuel Emil;Bottcher, Morten
通讯作者：
Bottcher, Morten
影响因子：
3.9
作者：
Schmidt M;Schmidt SA;Sandegaard JL;Ehrenstein V;Pedersen L;Sørensen HT
通讯作者：
Sørensen HT
影响因子：
39.3
作者：
Reeh, Jacob;Therming, Christina Bachmann;Prescott, Eva
通讯作者：
Prescott, Eva