Validation of the European Society of Cardiology pre-test probability model for obstructive coronary artery disease

: Winther Simon, Schmidt Samuel Emil, Rasmussen Laust Dupont, Juárez Orozco Luis Eduardo, Steffensen Flemmin Hald, Bøtker Hans Erik, Knuuti Juhani, Bøttcher Morten; on behalf of The Western Denmark Cardiac CT Study Group

Publisher: Oxford University Press

: 2021

: European Heart Journal

: European heart journal

: Eur Heart J

: ehaa755

: 42

: 14

: 1401

: 1411

: 0195-668X

: 1522-9645

DOI: https://doi.org/10.1093/eurheartj/ehaa755

Estimation of pre-test probability (PTP) of disease in patients with suspected coronary artery disease (CAD) is a common challenge. Due to decreasing prevalence of obstructive CAD in patients referred for diagnostic testing, the European Society of Cardiology suggested a new PTP (2019-ESC-PTP) model. The aim of this study was to validate that model.Symptomatic patients referred for coronary computed tomography angiography (CTA) due to suspected CAD in a geographical uptake area of 3.3 million inhabitants were included. The reference standard was a combined endpoint of CTA and invasive coronary angiography (ICA) with obstructive CAD defined at ICA as a ≥50% diameter stenosis or fractional flow reserve ≤0.80 when performed. The 2019-ESC-PTP, 2013-ESC-PTP, and CAD Consortium basic PTP scores were calculated based on age, sex, and symptoms. Of the 42 328 identified patients, coronary stenosis was detected in 8.8% using the combined endpoint. The 2019-ESC-PTP and CAD Consortium basic scores classified substantially more patients into the low PTP groups (PTP < 15%) than did the 2013-ESC-PTP (64% and 65% vs. 16%, P < 0.001). Using the combined endpoint as reference, calibration of the 2019-ESC-PTP model was superior to the 2013-ESC-PTP and CAD Consortium basic score.The new 2019-ESC-PTP model is well calibrated and superior to the previously recommended models in predicting obstructive stenosis detected by a combined endpoint of CTA and ICA.