Related Experiment Video
Updated: May 13, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score
Louise H Bjerking1, Samuel E Schmidt2, Kim W Skak-Hansen1
1Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
Insights
The CADScor®System acoustic risk score can improve obstructive coronary artery disease (CAD) risk assessment. Adding this score to the AHA/ACC pre-test probability model reduces unnecessary diagnostic tests, supporting cost-effective decision-making.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Imaging
Background:
- The 2021 AHA/ACC guidelines introduced a new pre-test probability (PTP) model for obstructive coronary artery disease (CAD), recommending a 15% risk cut-off for further testing.
- The efficacy of incorporating the CADScor®System acoustic risk score into the AHA/ACC PTP model for improved risk stratification has not been evaluated.
Purpose of the Study:
- To assess if the CADScor®System acoustic risk score enhances the AHA/ACC PTP model's accuracy in categorizing obstructive CAD risk.
- To determine the impact of adding the CADScor®System score on diagnostic test utilization and cost-effectiveness.
Main Methods:
- A cohort of 2874 patients with suspected CAD undergoing coronary CT angiography and same-day CADScor®System assessment were analyzed.
- Pre-test probability (PTP) was calculated using sex, age, and symptoms. A CADScor®System score ≤ 20 was used to define low CAD likelihood.
- Coronary CT angiography findings guided referral for invasive angiography in cases of suspected stenosis.
Main Results:
- The AHA/ACC PTP model categorized 71% of patients as >15% risk. Of these, 18.9% were reclassified to low likelihood by a CADScor®System score ≤ 20.
- In specific subgroups (e.g., <70 years, no hypertension), 37% were reclassified to low probability.
- For patients with low PTP (≤15%), 68.7% had a CADScor®System score ≤ 20, suggesting a strategy for deferred testing.
Conclusions:
- Integrating the acoustic CADScor®System score with the AHA/ACC PTP model for patients with >15% risk can decrease diagnostic tests by 19% overall (37% in subgroups).
- This approach supports cost-effective clinical decision-making and aids risk stratification, particularly for patients with an AHA/ACC PTP ≤ 15%.
Background:
The American Heart Association/American College of Cardiology (AHA/ACC) 2021 Chest Pain Guidelines introduced a new pre-test probability (PTP) model for obstructive coronary artery disease (CAD). The model recommends a 15 % risk cut-off for referral for further testing. Whether addition of a risk score measured from acoustic detection of coronary turbulence obtained by the noninvasive device CADScor®System (CAD-score) improves the AHA/ACC-PTP capability to assign the correct risk category has not been tested.
Methods:
Patients with symptoms suggestive of CAD referred for coronary CT angiography and undergoing a same-day CAD-score were included. PTP was calculated based on sex, age, and symptoms. All patients with suspected stenosis on CT angiography were referred for invasive angiography. A CAD-score ≤ 20 was used as cut-off for low likelihood of CAD.
Results:
The study population consisted of 2874 patients (47 % women, median age [IQR] 58 [52-65] years). PTP categorized 2044 (71 %) of patients as > 15 % amongst whom 387 (18.9 %) were re-classified to low likelihood by a CAD-score ≤ 20. In patients aged < 70 without hypertension, 37 % were re-classified to low probability. Of the 830 patients with low PTP ≤ 15 %, 68.7 % had a CAD-score ≤ 20 indicating a deferred testing strategy.
Conclusion:
Adding an acoustic-based CAD-score to the PTP in patients with AHA/ACC defined-PTP > 15 % risk can reduce the number of diagnostic tests by overall 19 %, and 37 % in subgroups, and may support cost-effective clinical decision-making. Moreover, CAD-score may aid risk stratification in patients, particularly with AHA/ACC-PTP ≤ 15 %.
