Related Experiment Video

Updated: Sep 23, 2025

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

546

Prediction models as gatekeepers for diagnostic testing in angina patients with suspected chronic coronary syndrome

Louise Hougesen Bjerking1, Simon Winther2, Kim Wadt Hansen1

  • 1Department of Cardiology, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.

European Heart Journal. Quality of Care & Clinical Outcomes
|May 16, 2022
PubMed

Insights

A validated clinical prediction model for coronary artery disease (CAD) effectively identifies patients needing further testing. This model improves upon current guidelines by better stratifying risk and reducing unnecessary diagnostic procedures for coronary artery disease.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Predictive Analytics

Background:

  • Pre-test probability (PTP) assessment is crucial for selecting patients for coronary artery disease (CAD) diagnostic testing.
  • The 2019 European Society of Cardiology (ESC) guidelines suggest risk factor-based PTP upgrades but lack specific estimations.
  • Contemporary cohorts have lower CAD prevalence, necessitating updated validation of PTP models.

Purpose of the Study:

  • To validate two published PTP models in a current low-CAD-prevalence population.
  • To compare the performance of these models against the ESC 2019 PTP.
  • To evaluate the clinical utility of different PTP models in a real-world setting.

Main Methods:

  • Validation of basic, clinical, and ESC 2019 PTP models in 42,328 patients undergoing coronary computed tomography angiography.
  • Analysis of model discrimination using the area under the receiver operating curve (AUC).
  • Assessment of model calibration and clinical impact at a ≤5% CAD probability cut-off.

Main Results:

  • All models demonstrated good discrimination (AUCs ranging from 0.74-0.76).
  • The ESC 2019 PTP overestimated CAD prevalence, while basic and clinical models were well-calibrated at ≤5% probability.
  • The clinical model ruled out 36.2% more patients than the ESC 2019 PTP at the ≤5% cut-off, with a manageable increase in missed obstructive CAD cases (3.6% vs 22.2%).

Conclusions:

  • A validated prediction model incorporating cardiovascular risk factors for CAD is presented.
  • Implementing this model could significantly reduce the need for diagnostic testing.
  • The model can serve as an effective gatekeeper, enabling a watchful waiting strategy for a substantial proportion of patients.
Abstract

Keywords:
Chronic coronary syndromeExternal validationPre-test probabilityPrediction modelRisk stratification

More Related Videos

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

5.3K
Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders05:58

Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders

Published on: February 3, 2021

3.8K

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
27
Angina III: Clinical Manifestations and Assessment01:29

Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
41
Angina V: Nursing Management01:20

Angina V: Nursing Management

Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
60
Angina II: Classification01:27

Angina II: Classification

Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...
46
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
58
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
41