Validation of European Society of Cardiology pre-test probabilities for obstructive coronary artery disease in suspected stable angina.
Validation of European Society of Cardiology pre-test probabilities for obstructive coronary artery disease in suspected stable angina.
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欧洲心脏病学学会的验证预测冠状动脉疾病的预测试概率可疑稳定心绞痛。
DOI：
10.1093/ehjqcco/qcaa006
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发表时间：
2020-10-01
期刊：
影响因子：
--
通讯作者：
Newby DE
中科院分区：
文献类型：
--
作者：
Bing R;Singh T;Dweck MR;Mills NL;Williams MC;Adamson PD;Newby DE
评估稳定性胸痛患者阻塞性冠状动脉疾病的当代预检验概率估计。在这项多中心随机对照试验的子研究中，我们比较了2019年欧洲心脏病学会（ESC）认可的预测试概率与计算机断层扫描冠状动脉造影（CTCA）观察到的阻塞性冠状动脉疾病患病率。我们评估了试验前概率、5年冠心病死亡或非致死性心肌梗死与研究干预（标准治疗与CTCA）之间的相关性。研究人群包括3755例患者（30-75岁，46%为女性），中位预检验概率为11%，其中1622例（43%）的预检验概率> 15%。在接受CTCA的患者（n = 1613）中，梗阻性疾病的患病率为22%。当划分为检验前概率的十分位数时，观察到的疾病患病率相似，但高于相应的中位检验前概率[中位差异2.3（1.3-5.6）%]。与5-15%和<5%的患者相比，预检验概率>15%的患者发生的临床事件更多（分别为4.1%、1.5%和1.4%，P < 0.001）。在整个队列中，接受CTCA的患者发生的临床事件较少，其中最大的差异是预检验概率>15%的患者（2.8% vs. 5.3%，对数秩P = 0.01），尽管这种相互作用在多变量建模中没有统计学意义。更新的2019年ESC指南预检验概率建议倾向于略微低估我们队列的疾病患病率。预试验概率是未来冠状动脉事件的有力预测因素，有助于选择可能从CTCA中获得最大绝对获益的患者。
To assess contemporary pre-test probability estimates for obstructive coronary artery disease in patients with stable chest pain. In this substudy of a multicentre randomized controlled trial, we compared 2019 European Society of Cardiology (ESC)-endorsed pre-test probabilities with observed prevalence of obstructive coronary artery disease on computed tomography coronary angiography (CTCA). We assessed associations between pre-test probability, 5-year coronary heart disease death or non-fatal myocardial infarction and study intervention (standard care vs. CTCA). The study population consisted of 3755 patients (30–75 years, 46% women) with a median pre-test probability of 11% of whom 1622 (43%) had a pre-test probability of >15%. In those who underwent CTCA (n = 1613), the prevalence of obstructive disease was 22%. When divided into deciles of pre-test probability, the observed disease prevalence was similar but higher than the corresponding median pre-test probability [median difference 2.3 (1.3–5.6)%]. There were more clinical events in patients with a pre-test probability >15% compared to those at 5–15% and <5% (4.1%, 1.5%, and 1.4%, respectively, P < 0.001). Across the total cohort, fewer clinical events occurred in patients who underwent CTCA, with the greatest difference in those with a pre-test probability >15% (2.8% vs. 5.3%, log rank P = 0.01), although this interaction was not statistically significant on multivariable modelling. The updated 2019 ESC guideline pre-test probability recommendations tended to slightly underestimate disease prevalence in our cohort. Pre-test probability is a powerful predictor of future coronary events and helps select those who may derive the greatest absolute benefit from CTCA.
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158.5
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