Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain
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Published:2023-01-28
Issue:1
Volume:23
Page:
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ISSN:1471-2261
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Container-title:BMC Cardiovascular Disorders
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language:en
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Short-container-title:BMC Cardiovasc Disord
Author:
Meng Jia,Jiang Hantao,Ren Kai,Zhou Jia
Abstract
Abstract
Background
The risk assessment of patients with stable chest pain (SCP) to defer further cardiovascular testing is crucial, but the most appropriate risk assessment strategy remains unknown. We aimed to compare current strategies to identify low risk SCP patients.
Methods
5289 symptomatic patients who had undergone coronary artery calcium score (CACS) and coronary computed tomographic angiography scan were identified and followed. Pretest probability (PTP) of obstructive coronary artery disease (CAD) for every patient was estimated according to European Society of Cardiology (ESC)-PTP model and CACS-weighted clinical likelihood (CACS-CL) model, respectively. Based on the 2019 ESC guideline-determined risk assessment strategy (ESC strategy) and CACS-CL model-based risk assessment strategy (CACS-CL strategy), all patients were divided into low and high risk group, respectively. Area under receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) was used.
Results
CACS-CL model provided more robust estimation of PTP than ESC-PTP model did, with a larger AUC (0.838 versus 0.735, p < 0.0001), positive IDI (9%, p < 0.0001) and less discrepancy between observed and predicted probabilities. As a result, compared to ESC strategy which only applied CACS-CL model to patients with borderline ESC-PTP, CACS-CL strategy incorporating CACS with estimation of PTP to entire SCP patients indicated a positive NRI (19%, p < 0.0001) and a stronger association to major adverse cardiovascular events, with hazard ratios: 3.97 (95% confidence intervals: 2.75–5.72) versus 5.11 (95% confidence intervals: 3.40–7.69).
Conclusion
The additional use of CACS for all SCP patients in CACS-CL strategy improved the risk assessment of SCP patients to identify individuals at low risk.
Funder
Key Natural Fund Projects of Tianjin Science and Technology Commission Applied and Basic Research by Multi-input Foundation of Tianjin Tianjin Health Research Project National Natural Science Foundation of China
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine
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