Author + information
- Adrian Chenzbraun,
- Sharmaine Thiru and
- Alexandros Alexopoulos
Background: An optimal strategy for pts with suspected angina (AP) remains elusive. UK and ESC guidelines use prediction models to guide management depending on the likelihood of coronary artery disease (CAD) estimated by symptoms, demographics and risk factors (NICE UK–Pryor model) or demographics and symptoms only (ESC–Diamond Forrester model). Data suggest that the models overestimate CAD risk. We assessed CAD prevalence as defined by obstructive CAD or positive functional test in pts investigated for chest pain (CP).
Methods: 1376 consecutive pts (age>30 yrs) were reviewed in a CP clinic. NICE model assigned pts to 5 CAD likelihood groups: < 10% (A), 10-29% (B), 30-60% (C), 61-90% (D) and > 90% (E). ESC model assigned pts to 3 likelihood groups: <15% (1), 15-85% (2) and >85% (3).
Results: 651 pts. (47%) had non-anginal CP, 413 pts. (30%) had atypical AP, 312 (23%) had typical AP. 415 pts (30%) were not investigated due to non-anginal symptoms or low CAD probability. Investigations were completed in 867/961 pts. Table: Expected and actual CAD prevalence.
CAD prevalence was 21% vs. 57% predicted by the NICE-Pryor model and 33% predicted by the ESC-Diamond Forrester one.
Conclusions: 1) CAD prevalence in suspected AP pts is significantly lower than the predicted one. 2) Historical models are accurate for very low risk pts but CAD risk is increasingly overestimated in higher risk groups. 3) The use of risk factors in addition to demographics and symptoms characteristics increases the degree of overestimation.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-329
- 2017 American College of Cardiology Foundation