Key result
In patients with low clinical likelihood of CAD, a PROMISE Minimal Risk Score ≥34% identified a subgroup with risk of MI or death similar to very-low likelihood patients (HR 0.91; 95% CI 0.52-1.52).
Why the study?
To investigate whether the PROMISE Minimal Risk Score (PMRS) enables adjustment of the risk factor-weighted clinical likelihood of obstructive CAD.
Does the PROMISE Minimal Risk Score safely down-classify risk in stable patients with a low clinical likelihood of obstructive CAD?
Cohort (n=18,311)
Does the PROMISE Minimal Risk Score safely down-classify risk in stable patients with a low clinical likelihood of obstructive CAD?
Answers are grounded in this paper and cite their sources.
The PROMISE Minimal Risk Score enables safe down-classification of 1 in 6 patients with low clinical likelihood of obstructive CAD to a very-low clinical likelihood category, potentially reducing unnecessary testing.
AIMS: To investigate whether the PROMISE Minimal Risk Score (PMRS) enables adjustment of the risk factor-weighted clinical likelihood of obstructive CAD. METHODS AND RESULTS: Two cohorts of stable patients with new-onset chest pain were established: a diagnosis cohort (n = 4,298) and a prognosis cohort (n = 14,013). Patients were stratified by the risk factor-weighted clinical likelihood model, and patients with low (>5 to 15%) clinical likelihood were further stratified by the PMRS using a ≥ 34% cut-off. For the diagnosis cohort, obstructive CAD was defined invasively by fractional flow reserve ≤0.80. For the prognosis cohort, the primary endpoint was non-fatal myocardial infarction or all-cause death.In the diagnosis cohort, 1,669 (39%) patients had low (>5 to ≤15%) clinical likelihood, of whom 301/1,669 (18%) patients had a PMRS ≥34%. In these patients, the prevalence of obstructive CAD was 14/301 (4.7%), similar to patients with very-low (≤5%) clinical likelihood [64/1,667 (3.8%), p = 0.21]. In the prognosis cohort, 6,187 (44%) patients had low (>5 to ≤15%) clinical likelihood, of whom 993/6,187 (16%) patients had a PMRS ≥34%. In these patients, event rates were similar to patients with very-low (≤5%) clinical likelihood [hazard ratio, 0.91 (95% confidence interval, 0.52-1.52), p = 0.77]. Compared to patients with low (>5 to ≤15%) clinical likelihood and a PMRS <34%, the prevalence of obstructive CAD and risk were lower in patients with low (>5 to ≤15%) clinical likelihood and a PMRS ≥34% (p < 0.01 for both comparisons). CONCLUSION: In patients with low (>5 to ≤15%) clinical likelihood of obstructive CAD, the PMRS enables safe down-classification of 1 in 6 patients to a very-low (≤5%) clinical likelihood category. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifiers: NCT02264717, NCT03481712, NCT04707859, NCT01174550 and NCT01149590.
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Rasmussen et al. (2025) conducted a cohort in Stable patients with new-onset chest pain and low clinical likelihood of obstructive CAD (n=18,311). PROMISE Minimal Risk Score (PMRS) ≥34% vs. Very-low (≤5%) clinical likelihood was evaluated on Non-fatal myocardial infarction or all-cause death (HR 0.91, 95% CI 0.52-1.52, p=0.77). In patients with low clinical likelihood of CAD, a PROMISE Minimal Risk Score ≥34% identified a subgroup with risk of MI or death similar to very-low likelihood patients (HR 0.91; 95% CI 0.52-1.52).
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