Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac CT
Authors' conclusion
Combining the COME-CCT-PTP calculator with CTA provides more accurate prediction than the PTP or CTA alone for the diagnosis of obstructive CAD, for all chest pain subtypes.
Study context
- Population
- Patients clinically referred to invasive coronary angiography with stable chest pain, from 22 countriespatients with clinically indicated invasive coronary angiography, 65 studies
- Participants
- 5,332 participants
- Comparison
- Pretest probability (PTP) calculation alone and with computed tomography angiography (CTA) for diagnosing coronary artery disease (CAD)
- Outcome
- Accuracy (AUC): COME-CCT-PTP calculator vs original Diamond-Forrester model
Methodological details65 prospective diagnostic accuracy studies, mixed-effects logistic regression with a data set-specific random intercept for clustering
- 65 prospective diagnostic accuracy studies
- Mixed-effects logistic regression with a data set-specific random intercept for clustering
Pooled result
As reported in the abstract
COME-CCT-PTP calculator
0.68
AUC · 95% CI 0.66–0.69
Diamond-Forrester models
0.63
AUC · 95% CI 0.62–0.65
Further pooled results
AUC
| Outcome | CTA alone model | COME-CCT-PTP with CTA model |
|---|---|---|
| Accuracy (AUC): COME-CCT-PTP with CTA model vs either model alone | 0.81 (95% CI 0.80–0.82) | 0.86 (95% CI 0.85–0.87) |
Accuracy (AUC): COME-CCT-PTP with CTA model vs either model alone
- Significantly improved accuracy compared with either model alone
Decision curve analysis and chest pain subtypes (COME-CCT-PTP with CTA model)
- Typical or atypical angina
- 0.85; 95% CI: 0.84-0.86
- Nonanginal or other chest discomfort
- 0.88; 95% CI: 0.86-0.89
- Increased net benefit for all chest pain subtypes
Original publication
Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac CT. JACC Adv. Published 28 July 2025. doi:10.
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