Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography
Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography
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DOI：
10.1161/01.cir.0000014483.43921.8c
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发表时间：
2002-04-16
期刊：
影响因子：
37.8
通讯作者：
Berman, D
中科院分区：
文献类型：
--
作者：
Budoff, MJ;Diamond, GA;Berman, D
背景：我们试图将电子束断层扫描得出的钙评分纳入一个预测血管造影上显著的冠状动脉疾病（CAD）的模型。这样的模型可以极大地促进无CAD症状患者的临床分诊。方法和结果：我们对1851例疑似冠心病患者进行了冠状动脉造影，以确定其临床适应症。所有患者均行电子束断层扫描。将每位患者的总钙评分和主要冠状动脉的单独评分添加到逻辑回归模型中，以计算血管造影疾病严重程度和程度的后验概率。这些模型设计为连续的，根据年龄和性别进行调整，纠正验证偏差，并根据其增量诊断准确性进行独立验证。冠脉钙预测血管造影阻塞性疾病的总体敏感性为95%，特异性为66%。当钙评分为>0、bbb80和>00时，预测狭窄的敏感性分别下降到90%、79%和76%，而特异性分别增加到58%、72%和75%。logistic回归模型具有良好的判别性（受试者工作特征曲线面积0.842 +/- 0.023）和校准（x(2)），拟合优度为8.95；P = 0.442)。结论：电子束断层钙扫描在预测有症状患者血管造影上明显的CAD的严重程度和范围方面提供了增量和独立的能力，并与疾病的抗议概率相结合。该算法在应用于中等风险人群时最有用。
Background-We sought to incorporate electron beam tomography-derived calcium scores in a model for prediction of angiographically significant coronary artery disease (CAD). Such a model could greatly facilitate clinical triage in symptomatic patients with no known CAD.Methods and Results-We examined 1851 patients with suspected CAD who underwent coronary angiography for clinical indications. An electron beam tomographic scan was performed in all patients. Total per-patient calcium scores and separate scores for the major coronary arteries were added to logistic regression models to calculate a posterior probability of the severity and extent of angiographic disease. These models were designed to be continuous, adjusted for age and sex, corrected for verification bias, and independently validated in terms of their incremental diagnostic accuracy. The overall sensitivity was 95%, and specificity was 66% for coronary calcium to predict obstructive disease on angiography. With calcium scores >20, >80, and >100, the sensitivity to predict stenosis decreased to 90%, 79%, and 76%, whereas the specificity increased to 58%, 72%, and 75%, respectively. The logistic regression model exhibited excellent discrimination (receiver operating characteristic curve area, 0.842 +/- 0.023) and calibration (x(2) goodness of fit, 8.95; P=0.442).Conclusions-Electron beam tomographic calcium scanning provides incremental and independent power in predicting the severity and extent of angiographically significant CAD in symptomatic patients, in conjunction with protest probability of disease. This algorithm is most useful when applied to an intermediate-risk population.