Why the study?
Does an updated clinical prediction model improve the prediction of obstructive CAD and prognosis compared to the modified Diamond-Forrester model in patients with suspected stable angina?
Population
3903 consecutive patients free of CAD and heart failure and suspected of angina, referred to a single centre…
Comparison
Updated clinical prediction model including age… vs Modified Diamond-Forrester prediction model.
Design
Cohort
Follow-up
mean 33 months
Key result
A clinical prediction model adding risk factors to age, gender, and symptoms improved discrimination for obstructive CAD over a basic model (C-statistic 0.88 vs 0.86; P<0.0001).
Authors
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May aid low-risk deferral in suspected angina; extends Diamond-Forrester yet requires prospective validation.
Cohort (n=3,903)
No
Does an updated clinical prediction model improve the prediction of obstructive CAD and prognosis compared to the modified Diamond-Forrester model in patients with suspected stable angina?
Absolute Event Rate: 0.88% vs 0.86%
p-value: p=<0.0001
The modified Diamond-Forrester model substantially overestimates CAD likelihood in contemporary patients, whereas an updated clinical prediction model provides better diagnostic and prognostic stratification, allowing safe deferral of non-invasive testing in low-risk subgroups.
Reeh et al. (2018) conducted a cohort in Suspected stable angina (n=3,903). Clinical prediction model (age, gender, symptoms, diabetes, family history, dyslipidaemia) vs. Basic prediction model (age, gender, symptoms) was evaluated on Discrimination for obstructive CAD (C-statistic) (p=<0.0001). A clinical prediction model adding risk factors to age, gender, and symptoms improved discrimination for obstructive CAD over a basic model (C-statistic 0.88 vs 0.86; P<0.0001).