Author + information
- Philip Lavenburg,
- Gregg Cantor,
- Olufunmilayo Agunloye,
- Ivan Crnosija,
- Erin Taub,
- Pamela Noack,
- Michael Poon and
- Getu Teressa
Non-invasive testing of acute chest pain patients without electrocardiogram (ECG) or biomarker evidence of ischemia results in low diagnostic yield. Our aim was to evaluate if coronary calcium score (CS) combined with Diamond-Forrester (DF) pretest probability can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE: acute myocardial infarction, revascularization, or mortality) in acute chest pain patients.
We retrospectively evaluated consecutive patients, age ≥ 18 years, with no known CAD, negative initial ECG and troponin. All patients had coronary CT angiography (CCTA) with CS measurement. Our final cohort consisted of 1,988 patients. Obstructive CAD was defined as luminal narrowing of ≥ 50 % in one or more vessels by CCTA. Pretest probability was calculated using the DF model and classified as low (<10 %), intermediate (10-90 %), or high (>90%).
When DF, CS, and DF+CS are compared, the C-statistics for predicting obstructive CAD was higher for CS alone, while DF+CS predicted 30-day MACE better (Table 1). Among patients with < 10% pretest probability by DF model, a zero CS had a NPV of 99.6% (CI 97.8-99.9%) for ruling out obstructive CAD and 100% (CI 98.6-100%) NPV for predicting 30-day MACE.
In patients with acute chest pain and low pretest probability by DF model, a zero CS rules out obstructive CAD and risk of a 30-day MACE.
Poster Hall, Hall A/B
Monday, March 12, 2018, 9:45 a.m.-10:30 a.m.
Session Title: Diagnosing Disease and Predicting Future Events: Here Is Your Crystal Ball!
Abstract Category: 02. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1305-444
- 2018 American College of Cardiology Foundation