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A Comparison of the Updated Diamond-Forrester, CAD Consortium, and CONFIRM History-Based Risk Scores for Predicting Obstructive Coronary Artery Disease in Patients With Stable Chest Pain: The SCOT-HEART Coronary CTA Cohort.

Authors
  • Baskaran, Lohendran1
  • Danad, Ibrahim2
  • Gransar, Heidi2
  • Ó Hartaigh, Bríain2
  • Schulman-Marcus, Joshua2
  • Lin, Fay Y2
  • Peña, Jessica M2
  • Hunter, Amanda3
  • Newby, David E3
  • Adamson, Philip D3
  • Min, James K4
  • 1 Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York; National Heart Centre, Singapore. , (Singapore)
  • 2 Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
  • 3 University of Edinburgh/BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom. , (United Kingdom)
  • 4 Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. Electronic address: [email protected]
Type
Published Article
Journal
JACC. Cardiovascular imaging
Publication Date
Jul 01, 2019
Volume
12
Issue
7 Pt 2
Pages
1392–1400
Identifiers
DOI: 10.1016/j.jcmg.2018.02.020
PMID: 29680338
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study sought to compare the performance of history-based risk scores in predicting obstructive coronary artery disease (CAD) among patients with stable chest pain from the SCOT-HEART study. Risk scores for estimating pre-test probability of CAD are derived from referral-based populations with a high prevalence of disease. The generalizability of these scores to lower prevalence populations in the initial patient encounter for chest pain is uncertain. We compared 3 scores among patients with suspected CAD in the coronary computed tomographic angiography (CTA) randomized arm of the SCOT-HEART study for the outcome of obstructive CAD by coronary CTA: the updated Diamond-Forrester score (UDF), CAD Consortium clinical score (CAD2), and CONFIRM risk score (CRS). We tested calibration with goodness-of-fit, discrimination with area under the receiver-operating curve (AUC), and reclassification with net reclassification improvement (NRI) to identify low-risk patients. In 1,738 patients (age 58 ± 10 years and 44.0% women), overall calibration was best for UDF, with underestimation by CRS and CAD2. Discrimination by AUC was highest for CAD2 at 0.79 (95% confidence interval [CI]: 0.77 to 0.81) than for UDF (0.77 [95% CI: 0.74 to 0.79]) or CRS (0.75 [95% CI: 0.73 to 0.77]) (p < 0.001 for both comparisons). Reclassification of low-risk patients at the 10% probability threshold was best for CAD2 (NRI 0.31, 95% CI: 0.27 to 0.35) followed by CRS (NRI 0.21, 95% CI: 0.17 to 0.25) compared with UDF (p < 0.001 for all comparisons), with a consistent trend at the 15% threshold. In this multicenter clinic-based cohort of patients with suspected CAD and uniform CAD evaluation by coronary CTA, CAD2 provided the best discrimination and classification, despite overestimation of obstructive CAD as evaluated by coronary CTA. CRS exhibited intermediate performance followed by UDF for discrimination and reclassification. Copyright © 2019. Published by Elsevier Inc.

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