A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac CT
Tekijät: Wieske, Viktoria; Walther, Mario; Mohamed, Mahmoud; Weickert, Benjamin; Andrzejewski, Simon; Dubourg, Benjamin; Andreini, Daniele; Pontone, Gianluca; Alkadhi, Hatem; Hausleiter, Jörg; Garcia, Mario J.; Leschka, Sebastian; Meijboom, Willem B.; Zimmermann, Elke; Gerber, Bernhard; Schoepf, U Joseph; Shabestari, Abbas A.; Nørgaard, Bjarne L.; Meijs, Matthijs FL.; Sato, Akira; Øvrehus, Kristian A.; Diederichsen, Axel CP.; Jenkins, Shona M.; Knuuti, Juhani; Hamdan, Ashraf; Halvorsen, Bjørn A.; Mendoza Rodriguez, Vladimir; Rochitte, Carlos; Rixe, Johannes; Wan, Yung-Liang; Langer, Christoph; Bettencourt, Nuno; Martuscelli, Eugenio; Ghostine, Said; Buechel, Ronny R.; Nikolaou, Konstantin; Mickley, Hans; Yang, Lin; Zhang, Zhaqoi; Chen, Marcus Y.; Halon, David A.; Rief, Matthias; Sun, Kai; Niinuma, Hiroyuki; Marcus, Roy P.; Muraglia, Simone; Jakamy, Réda; Chow, Benjamin JW.; Kaufmann, Philipp A.; Herzog, Bernhard A.; Tardif, Jean-Claude; Nomura, Cesar; Kofoed, Klaus F.; Laissy, Jean-Pierre; Arbab-Zadeh, Armin; Kitagawa, Kakuya; Laham, Roger; Jinzaki, Masahiro; Hoe, John; Rybicki, Frank J.; Scholte, Arthur; Paul, Narinder; Tan, Swee Yaw; Yoshioka, Kunihiro; Roehle, Robert; Schuetz, Georg M.; Laule, Michael; Newby, David E.; Achenbach, Stephan; Budoff, Matthew; Haase, Robert; Dodd, Jonathan D.; Dewey, Marc; Schlattmann, Peter; the COME-CCT Consortium
Kustantaja: Elsevier BV
Julkaisuvuosi: 2025
Journal: JACC: Advances
Tietokannassa oleva lehden nimi: JACC: Advances
Lehden akronyymi: JACC Adv
Artikkelin numero: 102014
Vuosikerta: 4
Numero: 8
eISSN: 2772-963X
DOI: https://doi.org/10.1016/j.jacadv.2025.102014
Verkko-osoite: https://doi.org/10.1016/j.jacadv.2025.102014
Rinnakkaistallenteen osoite: https://research.utu.fi/converis/portal/detail/Publication/499809542
Background
Combining pretest probability (PTP) with computed tomography angiography (CTA) for diagnosing obstructive coronary artery disease (CAD) has not yet been determined.
ObjectivesThe purpose of this study was to evaluate the accuracy of PTP calculation alone and with CTA for diagnosing CAD.
MethodsA 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.
ResultsIndividual 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).
ConclusionsCombining 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.
Ladattava julkaisu This is an electronic reprint of the original article. |  |
Julkaisussa olevat rahoitustiedot:
The COME-CCT Consortium is funded by a joint program of the German Research Foundation and the German Federal Ministry of Education and Research (01KG1110) and the Digital Health Accelerator of the Berlin Institute of Health to Dr Dewey. All researchers are independent of the funding bodies. The funding bodies had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the manuscript for publication. Dr Wieske has received grant support from the FP7 Program of the European Commission for the randomized multicenter DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2). Dr Pontone has received other grants from General Electric, grants from General Electric, other from Medtronic, other from Bracco, outside the submitted work. Dr Hoe is on the Speakers Bureau for Abbott Vascular and Edwards Lifesciences. Dr Gerber reports that the Cliniques St Luc UCL holds a master research agreement with Philips Medical Systems. Dr Schoepf has received institutional grants, personal fees, and nonfinancial support from Astellas, Bayer, General Electric, Guerbet, HeartFlow, and Siemens. Dr Nørgaard has received grants from Siemens and HeartFlow. AS has received personal fees from General Electric and Toshiba. Dr Knuuti has received grants from CardiRad and personal fees from GE Healthcare. Dr Buechel reports that the University Hospital Zurich holds a research contract with GE Healthcare. Dr Nikolaou reports collaborations with and project funding from Siemens Healthineers, Bayer Healthcare, GE Healthcare, and Speakers Bureau: Siemens Healthineers, Bayer Healthcare. Dr Chen has received an institutional research agreement with Canon Medical, formerly Toshiba Medical (no financial support/funding). Dr Halon has received other grant from Philips Healthcare, Cleveland, Ohio, during the conduct of the primary study. Dr Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research; has received research support from GE Healthcare and educational support from TeraRecon Inc during the conduct of the study. Dr Kaufmann reports that the University Hospital Zurich holds a research agreement with GE Healthcare. Dr Arbab-Zadeh has received grant support from Canon Medical Systems. Dr Paul is on the Speakers Bureau for Toshiba Medical Systems; and has received grants from Toshiba Medical Systems, outside the submitted work. Dr Schuetz has received grants support for his salary from German Federal Ministry of Education and Research (BMBF) during the conduct of the study. Dr Dewey has received grant support from the FP7 Program of the European Commission for the randomized multicenter DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2); also has received grant support from German Research Foundation (DFG) in the Heisenberg Program (DE 1361/14-1), graduate program on quantitative biomedical imaging (BIOQIC, GRK 2260/1), for fractal analysis of myocardial perfusion (DE 1361/18-1), the Priority Programme Radiomics for the investigation of coronary plaque and coronary flow (DE 1361/19-1 [428222922] and 20-1 [428223139] in SPP 2177/1); and also received funding from the Berlin University Alliance (GC_SC_PC 27) and from the Digital Health Accelerator of the Berlin Institute of Health. Dr Dewey has received lecture fees from Canon, Guerbet. Prof Dodd has received grant support from the Irish Lung Foundation, the St. Vincent’s Hospital Group Foundation, University College Dublin, and the FP7 Program of the European Commission for the randomized multicenter DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2); is an associate editor of Radiology, Respirology, and the Quarterly Journal of Medicine; is an Editorial Board member of Radiology Cardiothoracic Imaging; and is an author in the Stat-Dx book Series Diagnostic Imaging – Cardiovascular and the textbook CT and MRI in Cardiology, Elsevier and the opinions expressed in this article are the author’s own and do not represent the view of ESR. Per the guiding principles of ESR, the work as Research Chair is on a voluntary basis and only remuneration of travel expenses occurs. Dr Dewey is also the editor of Cardiac CT, published by Springer Nature, and offers hands-on courses on CT imaging (www.ct-kurs.de). Institutional master research agreements exist with Siemens, General Electric, Philips, and Canon. The terms of these arrangements are managed by the legal department of Charité–Universitätsmedizin Berlin. Dr Dewey holds a joint patent with Florian Michallek on dynamic perfusion analysis using fractal analysis (PCT/EP2016/071551). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
