Dual probability approach for risk adjustment in patients with a low clinical likelihood of coronary artery disease
Main finding · Non-fatal myocardial infarction or all-cause death (prognosis cohort)Result — go to the resultHazard ratio 0.91 95% CI 0.52–1.52Authors' conclusion
In patients with low (>5 to ≤15%) clinical likelihood of obstructive CAD, the PMRS enables safe down-classification of 1 in 6 patients to a very-low (≤5%) clinical likelihood category.
Study context
- Population
- Stable patients with new-onset chest pain, stratified by the risk factor-weighted clinical likelihood model; those with low (>5 to 15%) clinical likelihood further stratified by the PROMISE Minimal Risk Score (PMRS) using a ≥ 34% cut-offtwo cohorts · diagnosis cohort 4,298 · prognosis cohort 14,013
- Exposure
- Patients with low (>5 to ≤15%) clinical likelihood and a PMRS ≥34% vs patients with very-low (≤5%) clinical likelihood, and vs patients with low clinical likelihood and a PMRS <34%
- Low (>5 to ≤15%) clinical likelihood and a PMRS ≥34%n = 301/1,669 (diagnosis cohort); 993/6,187 (prognosis cohort)
- Very-low (≤5%) clinical likelihoodn = 1,667 (diagnosis cohort)reference
- Outcome
- Non-fatal myocardial infarction or all-cause death (prognosis cohort)
Methodological detailsdiagnosis cohort, prognosis cohort
- Diagnosis cohort
- Prognosis cohort
Main finding
As reported in the abstract
Hazard ratio
0.91
95% CI 0.52–1.52
P = 0.77
Low (>5 to ≤15%) clinical likelihood and a PMRS ≥34% vs very-low (≤5%) clinical likelihood
hazard ratio 0.91 (95% CI 0.52–1.52); P = 0.77
Observational data: associations, not effects.
Further findings
| Outcome | Low (>5 to ≤15%) clinical likelihood and a PMRS ≥34% | Very-low (≤5%) clinical likelihood | Low (>5 to ≤15%) clinical likelihood and a PMRS <34% | P value | |
|---|---|---|---|---|---|
| Prevalence of obstructive CAD (FFR ≤0.80; diagnosis cohort)Low (>5 to ≤15%) clinical likelihood and a PMRS ≥34% vs very-low (≤5%) clinical likelihood · similar | 4.7% | 3.8% | Not reported in the abstract | P = 0.21 | low (>5 to ≤15%) clinical likelihood and a PMRS <34%: not reported in the abstract |
| Prevalence of obstructive CAD and riskLow (>5 to ≤15%) clinical likelihood and a PMRS ≥34% vs low (>5 to ≤15%) clinical likelihood and a PMRS <34% · lower with PMRS ≥34% | P < 0.01 for both comparisons |
- Prevalence of obstructive CAD (FFR ≤0.80; diagnosis cohort): 1,669 (39%) patients in the diagnosis cohort had low (>5 to ≤15%) clinical likelihood, of whom 301/1,669 (18%) had a PMRS ≥34%
Original publication
Dual probability approach for risk adjustment in patients with a low clinical likelihood of coronary artery disease. Eur Heart J Cardiovasc Imaging. Published 1 July 2025. doi:10.
Summarised from the published abstract; every number is checked against it