Related Experiment Video
Updated: Sep 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
Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac
Viktoria Wieske1, Mario Walther2, Mahmoud Mohamed1
1Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Insights
Combining pretest probability (PTP) with computed tomography angiography (CTA) significantly improves the diagnosis of obstructive coronary artery disease (CAD). This combined approach offers more accurate predictions than PTP or CTA alone for all chest pain types.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Determining the diagnostic accuracy of combining pretest probability (PTP) with computed tomography angiography (CTA) for obstructive coronary artery disease (CAD) remains an area for investigation.
- Existing diagnostic models for CAD require further refinement to enhance accuracy in clinical practice.
Purpose of the Study:
- To evaluate the diagnostic accuracy of PTP calculation alone and in conjunction with CTA for identifying obstructive CAD.
- To compare the performance of novel PTP models against traditional methods in diagnosing CAD.
Main Methods:
- A meta-analysis of 65 prospective diagnostic accuracy studies involving patients with stable chest pain undergoing invasive coronary angiography.
- Development and comparison of four models: Diamond-Forrester, COME-CCT-PTP calculator, CTA alone, and a combined COME-CCT-PTP with CTA model, using mixed-effects logistic regression.
Main Results:
- Individual patient data from 5,332 patients across 22 countries were analyzed.
- The COME-CCT-PTP calculator demonstrated higher accuracy than the Diamond-Forrester model (AUC: 0.68 vs 0.63).
- The combined COME-CCT-PTP with CTA model significantly improved diagnostic accuracy (AUC: 0.86) compared to PTP alone (AUC: 0.81) or CTA alone.
Conclusions:
- The integration of the COME-CCT-PTP calculator with CTA provides a superior diagnostic prediction for obstructive CAD.
- This combined approach enhances diagnostic accuracy across all chest pain subtypes, outperforming PTP or CTA used independently.
Background:
Combining pretest probability (PTP) with computed tomography angiography (CTA) for diagnosing obstructive coronary artery disease (CAD) has not yet been determined.
Objectives:
The purpose of this study was to evaluate the accuracy of PTP calculation alone and with CTA for diagnosing CAD.
Methods:
A total of 65 prospective diagnostic accuracy studies of patients clinically referred to invasive coronary angiography with stable chest pain were included in this international collaborative individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT) meta-analysis. Mixed-effects logistic regression with a data set-specific random intercept for clustering was applied to 4 models: the traditional Diamond-Forrester models, a PTP model based on the COME-CCT data (termed COME-CCT-PTP calculator), a CTA alone model, and a combined COME-CCT-PTP with CTA model.
Results:
Individual patient data from 5,332 patients with clinically indicated invasive coronary angiography from 22 countries were included. The COME-CCT-PTP calculator was more accurate than the original Diamond-Forrester model (AUC: 0.68; 95% CI: 0.66-0.69 vs 0.63; 95% CI: 0.62-0.65). The COME-CCT-PTP with CTA model significantly improved accuracy compared with either model alone (AUC: 0.86; 95% CI: 0.85-0.87 vs 0.81; 95% CI: 0.80-0.82). The improved prediction was consistent in decision curve analysis with an increased net benefit for all chest pain subtypes and was almost equally seen in patients with typical or atypical angina (0.85; 95% CI: 0.84-0.86) and nonanginal or other chest discomfort (0.88; 95% CI: 0.86-0.89).
Conclusions:
Combining the COME-CCT-PTP calculator with CTA provides more accurate prediction than the PTP or CTA alone for the diagnosis of obstructive CAD, for all chest pain subtypes.
More Related Videos
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...