scholarly journals Differences between National Institute for Health and Care Excellence and European Society of Cardiology guidelines in the diagnosis of chest pain and stable coronary artery disease

2018 ◽  
Vol 13 (11-12) ◽  
pp. 385-385
Author(s):  
Diana Rudan ◽  
Hrvojka Marija Zeljko
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
European Society ◽  
Stable Coronary Artery Disease ◽  
Artery Disease ◽  
European Society Of Cardiology

scholarly journals Discrimination capability of pretest probability of stable coronary artery disease: a systematic review and meta-analysis suggesting how to improve validation procedures

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047677
Author(s):  
Pierpaolo Mincarone ◽  
Antonella Bodini ◽  
Maria Rosaria Tumolo ◽  
Federico Vozzi ◽  
Silvia Rocchiccioli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Quality Assessment ◽  
Meta Analysis ◽  
Stable Coronary Artery Disease ◽  
First Line ◽  
Discrimination Capability ◽  
Artery Disease

ObjectiveExternally validated pretest probability models for risk stratification of subjects with chest pain and suspected stable coronary artery disease (CAD), determined through invasive coronary angiography or coronary CT angiography, are analysed to characterise the best validation procedures in terms of discriminatory ability, predictive variables and method completeness.DesignSystematic review and meta-analysis.Data sourcesGlobal Health (Ovid), Healthstar (Ovid) and MEDLINE (Ovid) searched on 22 April 2020.Eligibility criteriaWe included studies validating pretest models for the first-line assessment of patients with chest pain and suspected stable CAD. Reasons for exclusion: acute coronary syndrome, unstable chest pain, a history of myocardial infarction or previous revascularisation; models referring to diagnostic procedures different from the usual practices of the first-line assessment; univariable models; lack of quantitative discrimination capability.MethodsEligibility screening and review were performed independently by all the authors. Disagreements were resolved by consensus among all the authors. The quality assessment of studies conforms to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A random effects meta-analysis of area under the receiver operating characteristic curve (AUC) values for each validated model was performed.Results27 studies were included for a total of 15 models. Besides age, sex and symptom typicality, other risk factors are smoking, hypertension, diabetes mellitus and dyslipidaemia. Only one model considers genetic profile. AUC values range from 0.51 to 0.81. Significant heterogeneity (p<0.003) was found in all but two cases (p>0.12). Values of I2 >90% for most analyses and not significant meta-regression results undermined relevant interpretations. A detailed discussion of individual results was then carried out.ConclusionsWe recommend a clearer statement of endpoints, their consistent measurement both in the derivation and validation phases, more comprehensive validation analyses and the enhancement of threshold validations to assess the effects of pretest models on clinical management.PROSPERO registration numberCRD42019139388.

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

2020 ◽  
Author(s):  
Simon Winther ◽  
Samuel Emil Schmidt ◽  
Laust Dupont Rasmussen ◽  
Luis Eduardo Juárez Orozco ◽  
Flemming Hald Steffensen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
European Society ◽  
Probability Model ◽  
Invasive Coronary Angiography ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease ◽  
European Society Of Cardiology ◽  
Test Probability

Abstract Aims  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. Methods and results  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 &lt; 15%) than did the 2013-ESC-PTP (64% and 65% vs. 16%, P &lt; 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. Conclusion  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.

Myocardial perfusion scintigraphy: clinical value

2017 ◽  
Author(s):  
Nikant Sabharwal ◽  
Parthiban Arumugam ◽  
Andrew Kelion
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Coronary Revascularization ◽  
Stable Coronary Artery Disease ◽  
Hibernating Myocardium ◽  
Perfusion Scintigraphy ◽  
Artery Disease

Myocardial perfusion scintigraphy (MPS) is most commonly used to diagnose or exclude obstructive coronary disease in patients presenting with chest pain. This chapter covers the value of MPS in this context, as well as providing detail on the guidelines which help the clinician choose what investigations are appropriate for the patient presenting with chest pain. It also details a number of considerations related to the use of MPS, such as its cost-effectiveness and the prognosis value in the diagnosis of coronary artery disease compared to exercise ECG, X-ray computed tomographic coronary angiography, and other imaging investigations. Risk assessment prior to elective non-cardiac surgery is covered, with detailed attention paid to the challenges of assessing coronary artery disease special groups including women and patients with diabetes or renal disease. This chapter also covers assessment in known stable coronary artery disease, predicting the value of coronary revascularization and hibernating myocardium.

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