Risk stratification of patients suspected of coronary artery disease: Comparison of five different models

Jensen, Jesper Møller; Voß, M.; Hansen, Vibeke Bøgelund; Andersen, Lars Vabbersgaard; Johansen, Peter; Munkholm, Henrik; Nørgaard, Bjarne Linde

doi:10.1016/j.atherosclerosis.2011.11.027

Cited by 46 publications

(40 citation statements)

References 22 publications

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“…The PTP score proved to be a good tool for risk stratifying patients presenting with chest pain, and the diagnostic accuracy seems to be equal or even higher than that of most other risk scores [3]. However, based on our results, the risk estimated by PTP still seems to be exaggerated, as was found with the old DFS [9].…”

Section: Discussioncontrasting

confidence: 48%

“…It is recommended that patients hospitalized on suspicion of an acute coronary syndrome with normal ECG at rest, normal biomarkers and no inhospital recurrence of chest pain are initially assessed by the updated Diamond and Forrester Score (DFS) [2]. The DFS has been shown to equal other well-established and more complex risk scores in terms of diagnostic accuracy [3]. With this score, patients with a low pretest probability (PTP) should have no further diagnostic work-up, patients with an intermediate PTP should be referred for noninvasive stress testing and patients with a high PTP should be considered for invasive coronary angiography (ICA).…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

et al. 2015

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Objectives: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. Methods: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. Results: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). Conclusions: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

et al. 2015

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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%

“…These range from a simple assessment of age, gender and type of chest pain to algorithms that incorporate risk factors for CAD, features of the physical examination, assessment of functional capacity and/or severity of presumed angina symptoms [4,11,14,19,20,22,23,28,31,32,34,35,36,40,45,48]. Importantly, of all the elements represented, no element is common to all algorithms.…”

Section: Resultsmentioning

confidence: 99%

“…Some of the algorithmic approaches have been compared to each other [36], and the approach with the best diagnostic potential, based on area under the curve analysis, was the Duke Score. However, this clinical diagnostic and prognostic algorithm did not perform significantly better than the CORSCORE or even the updated Diamond-Forrester method.…”

Section: Discussionmentioning

confidence: 99%

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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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Comparison of Coronary Artery Disease Consortium 1 and 2 Scores and Duke Clinical Score to Predict Obstructive Coronary Disease by Invasive Coronary Angiography

Almeida

Fonseca

Dias

et al. 2016

Clinical Cardiology

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Background The first step in evaluating a patient with suspected stable coronary artery disease (CAD) is the determination of the pretest probability. The European Society of Cardiology guidelines recommend the use of the CAD Consortium 1 score (CAD1), which contrary to CAD Consortium 2 (CAD2) score and Duke Clinical Score (DCS), does not include modifiable cardiovascular risk factors. Hypothesis Using scores that include modifiable risk factors (DCS and CAD2) enhances prediction of CAD. Methods We retrospectively included all patients referred to invasive coronary angiography for suspected CAD from January/2008–December/2012 (N = 2234). Pretest probability was calculated using 3 models (CAD1, DCS, and CAD2), and they were compared using the net reclassification improvement. Results Mean patient age was 63.7 years, 67.5% were male, and the majority (66.9%) had typical angina. Coronary artery disease was diagnosed in 58.5%, and the area under the curve was 0.685 for DCS, 0.664 for CAD1, and 0.683 for CAD2, with a statistically significant difference between CAD1 and the others (P < 0.001). The net reclassification improvement was 20% for DCS, related to adequate reclassification of 32% of patients with CAD to a higher risk category, and 5% for CAD2, at the cost of adequate reclassification of 34% of patients without CAD to a lower risk category. Conclusions Prediction of CAD using scores that include modifiable cardiovascular risk factors seems to improve accuracy. Our results suggest that, in high‐prevalence populations, DCS may better identify patients at higher risk and CAD2 those at lower risk for CAD.

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Risk stratification of patients suspected of coronary artery disease: Comparison of five different models

Cited by 46 publications

References 22 publications

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

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

Comparison of Coronary Artery Disease Consortium 1 and 2 Scores and Duke Clinical Score to Predict Obstructive Coronary Disease by Invasive Coronary Angiography

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