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External validation of novel clinical likelihood models to predict obstructive coronary artery disease and prognosis

Laust Dupont Rasmussen1,2, Michelle Claire Williams3, David E Newby3

  • 1Department of Cardiology, Gødstrup Hospital, Herning, Denmark lausra@rm.dk.

Open Heart
|December 6, 2023
PubMed

Insights

New clinical likelihood models, risk factor-weighted (RF-CL) and coronary artery calcium score-weighted (CACS-CL), better identify patients with very low risk of obstructive coronary artery disease (CAD). These models offer improved categorization with favorable long-term prognosis.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Risk Stratification

Background:

  • Obstructive coronary artery disease (CAD) diagnosis relies on accurate risk stratification.
  • Existing models like the European Society of Cardiology pretest probability (ESC-PTP) require external validation for novel approaches.
  • Risk factor-weighted clinical likelihood (RF-CL) and coronary artery calcium score-weighted clinical likelihood (CACS-CL) models aim to improve CAD risk assessment.

Purpose of the Study:

  • To externally validate the RF-CL and CACS-CL models for identifying obstructive CAD and guiding revascularisation decisions.
  • To compare the performance of RF-CL and CACS-CL against the ESC-PTP model.
  • To investigate the long-term prognosis of patients categorized into very-low clinical likelihood groups.

Main Methods:

  • A cohort of 1585 stable chest pain patients undergoing coronary CT angiography (CTA) was analyzed.
  • Obstructive CAD was defined as >70% diameter stenosis on CTA.
  • Clinical likelihood scores (ESC-PTP, RF-CL, CACS-CL) were calculated, and revascularisation decisions were recorded. Patient outcomes were followed for 5 years.

Main Results:

  • Both RF-CL and CACS-CL models classified significantly more patients into the very-low clinical likelihood (<5%) group compared to ESC-PTP (52.2% and 41.4% vs. 19.2%, p<0.001).
  • In the very-low likelihood group, prevalences of obstructive CAD (≤6%) and revascularisation (<1%) were low.
  • This low-risk group demonstrated a favorable prognosis with a low rate of non-fatal myocardial infarction or cardiovascular death over 5 years.

Conclusions:

  • The RF-CL and CACS-CL models provide improved categorization of patients with suspected obstructive CAD into a very-low risk group.
  • These novel models demonstrate preserved accuracy in identifying obstructive CAD and revascularisation needs within the low-risk stratum.
  • The validated models indicate a favorable long-term prognosis for patients classified as very-low risk, supporting their clinical utility.
Abstract

Keywords:
Angina PectorisCORONARY ARTERY DISEASEChest PainOutcome Assessment, Health CareRisk Factors

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