Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac CT

Figures

• 

  Figure 1. Eligibility Assessment and Inclusion Patients with stable chest pain, complete information on age, sex, and chest pain symptom, without known CAD and information on ICA and CTA were available for inclusion.12 CAD = coronary artery disease; CTA = computed tomography angiography; ICA = invasive coronary angiography.

• 

  Figure 2. Discriminative Ability of Prediction Models Panel (A) shows the receiver-operating characteristic (ROC) curves of the clinical probability prediction (PTP) models. The COME-CCT-PTP calculator (red) and updated Diamond-Forrester model (gray) resulted in significantly improved discrimination compared to the original Diamond-Forrester model (black). Panel (B) shows the significantly improved discriminative ability using the combination of the COME-CCT-PTP calculator with CTA (solid blue) compared to CTA alone (dashed blue). COME-CCT = Collaborative Meta-Analysis of Cardiac CT; DICAD = updated Diamond-Forrester model; other abbreviation as in Figure 1.

• 

  Figure 3. Decision Curves of the COME-CCT-PTP Calculator Alone, CTA Alone, and Combined COME-CCT-PTP Calculator and CTA The figure shows the net benefit of the COME-CCT-PTP calculator alone (red), combined with CTA (blue) and CTA alone (dashed blue) as a function of threshold probability. Patients are classified as test-positive (diagnosed with obstructive CAD) or test-negative (no CAD) based on their CAD probability. The net benefit based on the CTA alone model performed better than the COME-CCT-PTP calculator, and further improved by the combination. The black line represents the net benefit of considering all patients as having no CAD; the gray line represents the net benefit of considering all patients to have obstructive CAD. The intersection of the black with the gray line indicates the prevalence of obstructive CAD (48.3%) in our patient sample. PTP = pretest probability; other abbreviations as in Figure 1, Figure 2.

• 

  Central Illustration. Combining Pretest Probability Calculator With Cardiac CT Abbreviations as in Figure 1, Figure 2.