Accuracy of Traditional Age, Gender and Symptom Based Pre-Test Estimation of Angiographically Significant Coronary Artery Disease in Patients Referred for Coronary Computed Tomographic Angiography

Pickett, Chris A; Hulten, Edward; Goyal, Manju; Surry, Luke; Villines, Todd C.

doi:10.1016/j.amjcard.2013.03.015

Cited by 22 publications

(14 citation statements)

References 14 publications

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“…1) [4,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]. Of these, 29 consisted of both male and female participants, 2 included only males and 10 included only women.…”

Section: Resultsmentioning

confidence: 99%

Is It Time to Update How Suspected Angina Is Evaluated prior to the Use of Specialized Tests? Implications Based on a Systematic Review

Tashakkor

Stone²,

Mancini³

2015

Cardiology

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Objectives: Appropriate use of specialized tests to assess chest pain is based classically on minimal information such as age, gender and the patient's description of pain. This approach has not been reevaluated in decades. We examined the relationship between history, examination and routine laboratory tests to identify factors warranting prospective validation as predictors of underlying coronary artery disease (CAD). Methods: Studies linking obstructive CAD (≥50% diameter stenosis of at least one vessel by invasive angiography or cardiac computed tomographic angiography) and elements of history, examination and laboratory tests were identified. Results: Forty-one prospectively identified papers were analyzed. Advanced age, gender and chest pain descriptors were extremely important, although the last was less so in women, in whom the presence of risk factors may be more important. Physical examination and chest X-ray were largely noncontributory. Laboratory tests were of variable utility other than to identify risk factors not already known from the history. However, biomarkers such as troponin, brain natriuretic factor and inflammatory markers were promising. The electrocardiogram was mainly important for the identification of ST-T abnormalities. Conclusions: This review identifies the most promising factors warranting prospective validation for improving the pretest probability estimation of CAD, so appropriate use criteria for the utilization of specialized diagnostic tests can be updated and improved.

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Section: Resultsmentioning

confidence: 99%

Is It Time to Update How Suspected Angina Is Evaluated prior to the Use of Specialized Tests? Implications Based on a Systematic Review

Tashakkor

Stone²,

Mancini³

2015

Cardiology

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“…Основой для разработки этой шкалы послужил ретроспективный анализ 4952 боль-ных в американских клиниках, которым проведена инвазивная КАГ [14]. Однако значения ПТВ, полу-ченные по этому калькулятору, значительно завы-шены при сопоставлении с реально выявленными обструктивными поражениями КА, что показали исследования последних лет [9,15,16].…”

Section: оценка претестовой вероятности ибс (базовые модели)unclassified

“…Так, в исследовании Pickett CA, et al [16] среди 1027 больных у 4% были неангинозные боли в грудной клетке, у 63% -атипичная стенокар-дия, у 7% -типичная стенокардия и 26% пациентов были асимптомными. Частота выявления гемодина-мически значимых стенозов у больных с кардиалгией составила 3%, при атипичной стенокардии -9%, при типичной стенокардии -19%, при отсутствии сим-птомов -9% (p<0,001).…”

Section: оценка претестовой вероятности ибс (базовые модели)unclassified

“…Частота выявления гемодина-мически значимых стенозов у больных с кардиалгией составила 3%, при атипичной стенокардии -9%, при типичной стенокардии -19%, при отсутствии сим-птомов -9% (p<0,001). Шкала Diamond-Forrester существенно завышала частоту реально выявляемых стенозов КА при всех типах болевого синдрома, в разных возрастах и независимо от пола (p<0,001 во всех случаях) [16]. В схожем по дизайну исследова-нии CONFIRM [15] при проведении МСКТ-АГ наблюдаемая частота обструктивных поражений КА (стенозы ≥50%) оказалась существенно ниже пред-сказанной как в целом в когорте обследованных (18% против 51%, р<0,001), так и при наличии атипичной (15% против 47%) и типичной (29% против 86%) сте-нокардии.…”

Section: оценка претестовой вероятности ибс (базовые модели)unclassified

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The Assessment of Pretest Probability in Obstructive Coronary Lesion Diagnostics: Unresolved Issues

Сумин¹

2017

Russ J Cardiol

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“…Coronary artery disease · Diagnostic tests · Diamond-Forrester classification · Coronary angiography · Computed tomography Tatsächlich konnte in mehreren Analysen, in denen das Vorliegen einer KHK mittels CT-Koronarangiographie untersucht worden war, gezeigt werden, dass die Diamond-Forrester-Klassifikation das Vorliegen einer KHK überschätzte [16,17]. Fujimoto [21].…”

Section: Introductionunclassified

Diamond-Forrester und Kardio-CT

Schuhbäck

Kolwelter

Achenbach

2016

Herz

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Apart from the Diamond-Forrester classification, which is widely used particularly in the USA for the pretest probability of coronary artery disease, other scores also exist, such as an updated version of the classification table by Genders et al., the Morise score and the Duke clinical risk score. These scores estimate the probability of coronary artery disease, defined as the presence of at least one high-grade stenosis, based on symptom characteristics, age, gender and other parameters. All of the scores were derived from patient cohorts in which invasive coronary angiography had been performed for clinical reasons. It has subsequently been shown that these scores, especially those developed several decades ago, substantially overestimate the pretest probability of coronary artery disease. When these risk scores are applied to patients for whom a non-invasive work-up of suspected coronary artery disease is planned, for example by coronary computed tomography (CT) angiography, the expected prevalence of significant coronary stenosis will be overestimated. This, in turn, influences the test characteristics and the significance of the non-invasive examination (positive and negative predictive values) and needs to be taken into account when interpreting test results.

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Accuracy of Traditional Age, Gender and Symptom Based Pre-Test Estimation of Angiographically Significant Coronary Artery Disease in Patients Referred for Coronary Computed Tomographic Angiography

Cited by 22 publications

References 14 publications

Is It Time to Update How Suspected Angina Is Evaluated prior to the Use of Specialized Tests? Implications Based on a Systematic Review

Is It Time to Update How Suspected Angina Is Evaluated prior to the Use of Specialized Tests? Implications Based on a Systematic Review

The Assessment of Pretest Probability in Obstructive Coronary Lesion Diagnostics: Unresolved Issues

Diamond-Forrester und Kardio-CT

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