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

• Published in: European heart journal Vol. 42; no. 14; pp. 1401 - 1411
• Main Authors: Winther, Simon, Schmidt, Samuel Emil, Rasmussen, Laust Dupont, Juárez Orozco, Luis Eduardo, Steffensen, Flemming Hald, Bøtker, Hans Erik, Knuuti, Juhani, Bøttcher, Morten
• Format: Journal Article
• Language: English
• Published: England 07.04.2021
• Subjects: Computed tomography angiography; Stable coronary artery disease; Chronic coronary syndrome; Coronary artery disease; Coronary stenosis; Pre-test probability
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 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.