Diagnostic performance of clinical likelihood models of obstructive coronary artery disease to predict myocardial perfusion defects
Authors' conclusion
Compared with basic CL models, the RF-CL and CACS-CL models improve down classification of patients to a very low-risk group with a low prevalence of MPD.
Study context
- Population
- Symptomatic stable de novo chest pain patients undergoing coronary CT angiography and subsequent myocardial perfusion imaging (SPECT, PET or CMR)219 (6.5%) with MPD
- Participants
- 3,374 patients
- Comparison
- RF-CL and CACS-CL models vs European Society of Cardiology pre-test probability (ESC-PTP) for diagnosing myocardial perfusion defects (MPDs)
- Outcome
- Diagnosis of myocardial perfusion defects (suspected stenosis on coronary CT angiography and stress-perfusion abnormality in ≥2 segments)
Performance
As reported in the abstract
Discrimination of MPD
| Test or model | AUC | Low clinical likelihood (CL) (<5%) |
|---|---|---|
| ESC-PTP | 0.74 (0.71-0.78) | 12.0% |
| RF-CL | 0.73 (0.70-0.76) | 32.5 |
| CACS-CL | 0.88 (0.86-0.91) | 54.1 |
AUC
ESC-PTP0.74 (0.71-0.78)
RF-CL0.73 (0.70-0.76)
CACS-CL0.88 (0.86-0.91)
Low clinical likelihood (CL) (<5%)
ESC-PTP12.0%
RF-CL32.5
CACS-CL54.1
- CACS-CL vs ESC-PTP: P < 0.001 — higher discrimination
- RF-CL vs ESC-PTP: P = 0.32 — similar discrimination
- RF-CL and CACS-CL vs ESC-PTP: P < 0.001 — 32.5 and 54.1 vs. 12.0%
- Prevalence of MPD in low CL group, all models
- <2%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Diagnostic performance of clinical likelihood models of obstructive coronary artery disease to predict myocardial perfusion defects. Eur Heart J Cardiovasc Imaging. Published 7 June 2023. doi:10.
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