TY - JOUR
T1 - Simplified Approach to Predicting Obstructive Coronary Disease With Integration of Coronary Calcium
T2 - Development and External Validation
AU - Miller, Robert J.H.
AU - Gransar, Heidi
AU - Rozanski, Alan
AU - Dey, Damini
AU - Al-Mallah, Mouaz
AU - Chow, Benjamin J.W.
AU - Kaufmann, Philipp A.
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Han, Donghee
AU - Slomka, Piotr J.
AU - Berman, Daniel S.
N1 - Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/12/19
Y1 - 2023/12/19
N2 - BACKGROUND: The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD. METHODS AND RESULTS: The training population included patients from 3 multinational sites (n=2055), with 2 sites for external testing (n=3321). We determined associations between age, sex, cardiac chest pain, and CAC with the presence of obstructive CAD, defined as any stenosis ≥50% on coronary computed tomography angiography. Prediction performance was assessed using area under the receiver-operating characteristic curves (AUCs) and compared with the CAD Consortium models with and without CAC, which require detailed calculations, and the updated Diamond-Forrester model. In external testing, the proposed likelihood tables had higher AUC (0.875 [95% CI, 0.862–0.889]) than the CAD Consortium clinical+CAC score (AUC, 0.868 [95% CI, 0.855–0.881]; P=0.030) and the updated Diamond-Forrester model (AUC, 0.679 [95% CI, 0.658–0.699]; P<0.001). The calibration for the likelihood tables was better than the CAD Consortium model (Brier score, 0.116 versus 0.121; P=0.005). CONCLUSIONS: We have developed and externally validated simple likelihood tables to integrate CAC with age, sex, and cardiac chest pain, demonstrating improved prediction performance compared with other risk models. Our tool affords physicians with the opportunity to rapidly and easily integrate a small number of important features to estimate a patient’s likelihood of obstructive CAD as an aid to clinical management.
AB - BACKGROUND: The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD. METHODS AND RESULTS: The training population included patients from 3 multinational sites (n=2055), with 2 sites for external testing (n=3321). We determined associations between age, sex, cardiac chest pain, and CAC with the presence of obstructive CAD, defined as any stenosis ≥50% on coronary computed tomography angiography. Prediction performance was assessed using area under the receiver-operating characteristic curves (AUCs) and compared with the CAD Consortium models with and without CAC, which require detailed calculations, and the updated Diamond-Forrester model. In external testing, the proposed likelihood tables had higher AUC (0.875 [95% CI, 0.862–0.889]) than the CAD Consortium clinical+CAC score (AUC, 0.868 [95% CI, 0.855–0.881]; P=0.030) and the updated Diamond-Forrester model (AUC, 0.679 [95% CI, 0.658–0.699]; P<0.001). The calibration for the likelihood tables was better than the CAD Consortium model (Brier score, 0.116 versus 0.121; P=0.005). CONCLUSIONS: We have developed and externally validated simple likelihood tables to integrate CAC with age, sex, and cardiac chest pain, demonstrating improved prediction performance compared with other risk models. Our tool affords physicians with the opportunity to rapidly and easily integrate a small number of important features to estimate a patient’s likelihood of obstructive CAD as an aid to clinical management.
KW - cardiovascular computed tomography
KW - coronary artery disease
KW - epidemiology
KW - risk estimation
UR - http://www.scopus.com/inward/record.url?scp=85180401396&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85180401396&partnerID=8YFLogxK
U2 - 10.1161/JAHA.123.031601
DO - 10.1161/JAHA.123.031601
M3 - Article
C2 - 38108259
AN - SCOPUS:85180401396
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 24
M1 - e031601
ER -