Performance of the Traditional Age, Sex, and Angina Typicality–Based Approach for Estimating Pretest Probability of Angiographically Significant Coronary Artery Disease in Patients Undergoing Coronary Computed Tomographic Angiography
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Key result
Guideline probabilities overestimated the prevalence of CAD50 by 33% and CAD70 by 32% compared to actual findings in patients undergoing coronary CT angiography.
Why the study?
Does the traditional age, sex, and angina typicality-based approach accurately estimate the prevalence of angiographically significant CAD in patients undergoing coronary computed tomographic angiography?
Population
14,048 consecutive adult patients with suspected coronary artery disease who underwent clinically indicated…
Comparison
Estimation of pretest probability of… vs Actual observed prevalence of angiographically…
Design
Cohort
Authors
Discussion
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Implication
Guideline probabilities may overestimate CAD prevalence in CT angiography referrals; challenges consensus and leaves open updated pretest models.
Structured PICO
Does the traditional age, sex, and angina typicality-based approach accurately estimate the prevalence of angiographically significant CAD in patients undergoing coronary computed tomographic angiography?
P
Population
14,048 consecutive adult patients with suspected coronary artery disease (CAD) who underwent clinically indicated coronary computed tomographic angiography (CCTA). Mean age 57 for men (n=7,719) and 60 for women (n=6,329). Excluded: known CAD, suspected acute coronary syndrome, age <30 years, and incomplete symptom information.
I
Intervention
Estimation of pretest probability of angiographically significant CAD using traditional ACC/AHA guideline probabilities based on age, sex, and angina typicality.
C
Comparator
Actual observed prevalence of angiographically significant CAD as determined by coronary computed tomographic angiography (CCTA).
O
Outcome
Prevalence of angiographically significant CAD (≥50% diameter stenosis [CAD50] and ≥70% diameter stenosis [CAD70]) compared to expected guideline probabilities.surrogate
Traditional ACC/AHA guideline probabilities based on age, sex, and angina typicality significantly overestimate the actual prevalence of angiographically significant CAD in contemporary patients referred for noninvasive testing.
Limitations
- Predicated on an accurate exclusion of CAD50 by coronary CTA, which may be affected by nondiagnostic segments or severe coronary calcification
Cite This Study
Cheng et al. (2011) studied this question. Guideline probabilities overestimated the prevalence of CAD50 by 33% and CAD70 by 32% compared to actual findings in patients undergoing coronary CT angiography.
Topics
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