Coronary calcium score improves the estimation for pretest probability of obstructive coronary artery disease and avoids unnecessary testing in individuals at low extreme of traditional risk factor burden: validation and comparison of CONFIRM score and genders extended model

Abstract

BackgroundReliability of models for estimating pretest probability (PTP) of obstructive coronary artery disease (CAD) has not been investigated in individuals at low extreme of traditional risk factor (RF) burden. Thus, we sought to validate and compare CONFIRM score and Genders extended model (GEM) among these individuals.MethodsWe identified symptomatic individuals with 0 or 1 RF who underwent coronary calcium scan and coronary computed tomographic angiography (CCTA). Follow-up clinical data were also recorded. PTP of obstructive CAD for every individual was estimated according to CONFIRM score and GEM, respectively. Area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and Hosmer–Lemeshow (H-L) test were used to assess the performance of models.ResultsThere were 1201 individuals with 0 RF and 2415 with 1 RF. The AUC for GEM was significantly larger than that for CONFIRM score, no matter in individuals with 0 (0.843 v.s. 0.762, p < 0.0001) or 1 (0.823 v.s. 0.752, p < 0.0001) RF. Compared to CONFIRM score, GEM demonstrated positive IDI (5% in individuals with 0 RF and 8% in individuals with 1 RF), positive NRI (41.50% in individuals with 0 RF and 40.19% in individuals with 1 RF), better prediction of clinical events and less discrepancy between observed and predicted probabilities, resulting in a significant decrease of unnecessary testing, especially in negative individuals.ConclusionIn individuals at low extreme of traditional RF burden of CAD, the addition of coronary calcium score provided a more accurate estimation for PTP and application of GEM instead of CONFIRM score could avoid unnecessary testing.

Gender Differences in Patients Admitted to a Certified German Chest Pain Unit: Results from the German Chest Pain Unit Registry

“…In summary, women admitted to a CPU were less often diagnosed with a coronary diagnosis than men with a leading noncoronary diagnosis being a hypertensive crisis. This confirms findings of the WISE and WISE-CVD studies in which higher rates of endothelial and microvascular dysfunction as noncoronary reasons and the CONFIRM study where lower rates of obstructive CVD in women have been reported [23-25]. Nearly half of the male patients (46.7%) and about two thirds of female patients (66.2%) of all patients presenting to a CPU with suspected ACS were found to have non-ACS diagnoses, underlining the importance of accessibility of a wide-spread diagnostic workup within the hospital, especially in female patients.…”

Lung disease severity, Coronary Artery Calcium, Coronary inflammation and Mortality in Coronavirus Disease 2019

“…Comparing patients discharged alive with patients who died, the median (lower-upper quartiles) age was 65 y/o (56-76) vs 77 y/o (72-82), (p<0.001), n=95 (56%) vs n=74 (68%) were males, p=0.061, dyslipidemia was present in n=29 (17%) vs n=30 (28%), p=0.052, n=15 (9) vs n=26 (24), p=0.001 had prior cardiovascular disease, D-dimer median was 723 ng/ml (lower-upper quartile, 495-1119) vs 1.083 ng/ml (lower-upper quartile, 704-2248), p<0.001, CRP median 78.15 mg/L (lower-upper quartile, 36.8-132.5) vs 148.3 mg/L (lower-upper quartile, 91-209.4), p<0.001, median CCS was 17 (lower-upper quartile, 0-248) vs 188.7 (lower-upper quartile, 20.3-671.6), p<0.001 and the PCAT attenuation median was −76.4 HU (lower-upper quartile, −79.3, −76.6) vs - 68.6 HU (lower-upper quartile, −75.9, −63.3), p<0.001. Figure 3 graphically shows the distribution of age, main laboratory and imaging variables according to the in-hospital outcome.…”

“…We aimed to investigate whether the Agatston coronary calcium score (CCS), which correlates with coronary artery disease (CAD) (9), or peri-coronary adipose tissue (PCAT) attenuation, which correlates with coronary inflammation (10), are associated with higher mortality in COVID-19 patients, independently from other risk factors and extent of lung disease. Both parameters can be measured in HRCT scans, although only CCS has been previously measured in non-contrast, non ECG-triggered HRCT scans (11).…”

Validated models for pre-test probability of stable coronary artery disease: a systematic review suggesting how to improve validation procedures

“…42 The substantially steady results of the CONFIRM score on several data-sets are also confirmed on a validation data-set consisting of subjects at the low extreme of traditional cardiovascular risk factor burden. 51…”

“…42 The substantially steady results of the CONFIRM score on several data-sets are also confirmed on a validation data-set consisting of subjects at the low extreme of traditional cardiovascular risk factor burden. 51 The Corus® CAD model stands out from the previous ones because it defines an ageand sex-specific gene expression score. Validation is performed by AUC comparisons, HL test and additivity to DFM and other models.…”