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Validation of pre-test probability model of coronary artery disease in the Portuguese population.

Session Poster session 1

Speaker Rui Azevedo Guerreiro

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : RA Guerreiro (Evora,PT), C Ruano (Lisbon,PT), C Soares (Penafiel,PT), F Santos (Leiria,PT), G Portugal (Lisbon,PT), L Gomes (Lisbon,PT), A Bento (Evora,PT), M Costa (Coimbra,PT), R Fernandes (Evora,PT), R Cacao (Coimbra,PT), R Ramos (Lisbon,PT), R Ferreira (Lisbon,PT), L Goncalves (Coimbra,PT), J Aguiar (Evora,PT)

Authors:
R.A. Guerreiro1 , C. Ruano2 , C. Soares3 , F. Santos4 , G. Portugal5 , L. Gomes6 , A. Bento1 , M. Costa7 , R. Fernandes1 , R. Cacao7 , R. Ramos8 , R. Ferreira8 , L. Goncalves7 , J. Aguiar1 , 1Hospital Espirito Santo de Evora, Cardiology - Evora - Portugal , 2Hospital dos Capuchos - Lisbon - Portugal , 3Hospital Centre do Tamega e Sousa - Penafiel - Portugal , 4Hospital Santo Andre - Leiria - Portugal , 5Hospital de Santa Marta - Lisbon - Portugal , 6Primary Health Cluster of Loures-Odivelas - Lisbon - Portugal , 7University Hospitals of Coimbra, Cardiology - Coimbra - Portugal , 8Hospital de Santa Marta, Cardiology - Lisbon - Portugal ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 192-193

Introduction: Pre-test probability (PTP) of coronary artery disease (CAD) can be calculated for a patient based on sex, age and symptoms. According to 2013 European Society of Cardiology (ESC) guidelines of stable coronary artery disease, the absence or presence of obstructive CAD can be assumed if PTP is below 15% or above 85%, respectively. However, actual PTP of CAD depends on the prevalence of CAD in the overall population. If PTP is not calibrated for the reality of a specific country, it can have consequences in the diagnostic management of patients.

Purpose: Authors propose to validate the updated and extended Diamond-Forrester model, currently adopted by ESC to calculate the PTP of CAD, in a sample of Portuguese patients.

Methods: Patients from three centers in Portugal, with chest pain suggestive of stable CAD, without previous diagnosis of CAD, who performed elective coronariography were included. PTP of CAD of each patient was calculated using the updated and extended Diamond-Forrester model. Patients were stratified by PTP (<15%, 15–65%, 66–85% and >85%) and the prevalence of CAD found in coronariography was calculated for each stratum. To validate the model, the percentage of false negatives (patients with PTP<15% with CAD) and false positives (patients with PTP>85% without CAD) were calculated.

Results: 4269 consecutive patients were included in the study [mean age 66.76 (± 9.83) years, 2821 (66.08%) men], of whom 2732 (64%) had CAD diagnosed by coronariography. Patients with CAD were older (67.41 vs 65.59 years, p<0.001), more frequently men (71.8% vs 56%, p<0.001), with higher prevalence of diabetes (35.2% vs 27.1%, p<0.001), hyperlipidaemia (64.5% vs 59.3%, p=0.008) and presented more often with typical angina (58.1% vs 43.1%, p<0.001). The prevalence of CAD in each PTP stratum was: <15% - 26.51%; 15–65% - 57.12%; 66–85% - 73.79%; >85% - 77.68% (Figure). There were 26.51% of false negatives and 22.32% of false positives.

Conclusion: The updated and extended Diamond-Forrester model failed validation in our sample of Portuguese patients due to a high percentage of false negatives and false positives.

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