Identification of Patients With Stable Chest Pain Deriving Minimal Value From Noninvasive Testing
Key result
A 10-variable clinical risk tool identified patients with stable chest pain at minimal risk for clinical events (C statistic 0.725), with severely abnormal test results occurring in 1.3% for CCTA and 5.6% for functional testing.
Why the study?
Can a clinical risk tool using pretest variables identify patients with stable chest pain who have normal coronary arteries and no clinical events?
Population
4,631 stable, symptomatic outpatients without known coronary artery disease referred for noninvasive testing…
Design
Cohort, randomized (original trial)
Follow-up
median 25 months
Authors
Discussion
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Member takes
Implication
May support deferral of testing in minimal-risk stable chest pain; leaves open prospective validation before practice change.
Study Design
Type
RCT (n=4,631)
Randomization
randomized
Multicenter
Yes
Structured PICO
Can a clinical risk tool using pretest variables identify patients with stable chest pain who have normal coronary arteries and no clinical events?
P
Population
4,631 stable, symptomatic outpatients without known coronary artery disease referred for noninvasive testing, followed for a median of 25 months.
I
Intervention
Clinical risk tool using 10 pretest variables (age, sex, race/ethnicity, hypertension, diabetes, dyslipidemia, family history of premature CAD, smoking status, symptom relation to stress, HDL level)
O
Outcome
Normal coronary arteries and no clinical events during follow-up (minimal-risk cohort)composite
Main Result
Absolute Event Rate: 1.3% vs 5.6%
A clinical tool using 10 pretest variables can identify over 25% of stable chest pain patients who have minimal risk of abnormal test results or clinical events, for whom deferred testing may be considered.
Cite This Study
Fordyce et al. (2017) conducted an RCT in stable chest pain (n=4,631). Coronary computed tomography angiography (CCTA) vs. Functional testing was evaluated on severely abnormal test results among patients at highest probability of minimal risk. A 10-variable clinical risk tool identified patients with stable chest pain at minimal risk for clinical events (C statistic 0.725), with severely abnormal test results occurring in 1.3% for CCTA and 5.6% for functional testing.