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Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

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Roehle, Robert Wieske, Viktoria Schuetz, Georg M Gueret, Pascal Andreini, Daniele Gerber, Bernhard [UCL] Dewey, Marc

(eng) OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2018
Language Anglais
Journal information "European Radiology" - Vol. 28, no. 9, p. 4006-4017 (2018)
Peer reviewed yes
Publisher Springer International ((Germany) Berlin)
issn 0938-7994
e-issn 1432-1084
Publication status Publié
Affiliations UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - (SLuc) Service de cardiologie
Keywords Coronary artery disease ; Duke clinical score ; Multidetector computed tomography ; NICE clinical guideline ; Pretest probability
Links
  1. Fihn SD, Gardin JM, Abrams J et al (2012) ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 126(25):e354–e471
  2. Nichols M, Townsend N, Luengo-Fernandez R et al (2012) European Cardiovascular Disease Statistics 2012. Brussels European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis
  3. Go AS, Mozaffarian D, Roger VL et al (2013) Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245
  4. Percutaneous coronary interventions in Europe in 2006, 10.4244/eijv6i2a31
  5. Patel MR, Dai D, Hernandez AF et al (2014) Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J 167(6):846–52.e2
  6. Montalescot G, Sechtem U, Achenbach S et al (2013) ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34(38):2949–3003
  7. Leber Alexander W., Johnson Thorsten, Becker Alexander, von Ziegler Franz, Tittus Janine, Nikolaou Konstantin, Reiser Maximilian, Steinbeck Gerhard, Becker Christoph R., Knez Andreas, Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease, 10.1093/eurheartj/ehm294
  8. Schuetz Georg M., Meta-analysis: Noninvasive Coronary Angiography Using Computed Tomography Versus Magnetic Resonance Imaging, 10.7326/0003-4819-152-3-201002020-00008
  9. Meijboom W. Bob, Meijs Matthijs F.L., Schuijf Joanne D., Cramer Maarten J., Mollet Nico R., van Mieghem Carlos A.G., Nieman Koen, van Werkhoven Jacob M., Pundziute Gabija, Weustink Annick C., de Vos Alexander M., Pugliese Francesca, Rensing Benno, Jukema J. Wouter, Bax Jeroen J., Prokop Mathias, Doevendans Pieter A., Hunink Myriam G.M., Krestin Gabriel P., de Feyter Pim J., Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography, 10.1016/j.jacc.2008.08.058
  10. von Ballmoos Moritz Wyler, Haring Bernhard, Juillerat Pascal, Alkadhi Hatem, Meta-analysis: Diagnostic Performance of Low-Radiation-Dose Coronary Computed Tomography Angiography, 10.7326/0003-4819-154-6-201103150-00007
  11. Schlattmann Peter, Schuetz Georg M., Dewey Marc, Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis, 10.1007/s00330-011-2142-2
  12. Cooper A, Calvert N, Skinner J et al (2010) Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. London: National Clinical Guideline Centre for Acute and Chronic Conditions
  13. Value of the History and Physical in Identifying Patients at Increased Risk for Coronary Artery Disease, 10.7326/0003-4819-118-2-199301150-00001
  14. Individual patient data meta-analysis for the clinical assessment of coronary computed tomography angiography: protocol of the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT), 10.1186/2046-4053-2-13
  15. Pryor David B., Harrell Frank E., Lee Kerry L., Califf Robert M., Rosati Robert A., Estimating the likelihood of significant coronary artery disease, 10.1016/0002-9343(83)90406-0
  16. Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300(24):1350–1358
  17. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts, 10.1136/bmj.e3485
  18. Cheng V. Y., Berman D. S., Rozanski A., Dunning A. M., Achenbach S., Al-Mallah M., Budoff M. J., Cademartiri F., Callister T. Q., Chang H.-J., Chinnaiyan K., Chow B. J. W., Delago A., Gomez M., Hadamitzky M., Hausleiter J., Karlsberg R. P., Kaufmann P., Lin F. Y., Maffei E., Raff G. L., Villines T. C., Shaw L. J., Min J. K., Performance of the Traditional Age, Sex, and Angina Typicality-Based Approach for Estimating Pretest Probability of Angiographically Significant Coronary Artery Disease in Patients Undergoing Coronary Computed Tomographic Angiography: Results From the Multinational Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (CONFIRM), 10.1161/circulationaha.111.039255
  19. Implementation of NICE Clinical Guideline 95 for investigation of "chest pain of recent onset" reduces cost, 10.1093/eurheartj/eht309.p3344
  20. Kelly D, Cole S, Rossiter F, Mallinson K, Smith A, Simpson I (2011) Implementation of the new NICE guidelines for stable chest pain: likely impact on chest pain services in the UK. Br J Cardiol 18(4):185–188
  21. Patterson C., Nicol E., Bryan L., Woodcock T., Collinson J., Padley S., Bell D., The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK, 10.1093/qjmed/hcr011
  22. Rogers Toby, Dowd Rory, Yap Hsiu Lye, Claridge Simon, Al Fakih Khaled, Byrne Jonathan, Strict application of NICE Clinical Guideline 95 ‘chest pain of recent onset’ leads to over 90% increase in cost of investigation, 10.1016/j.ijcard.2012.09.180
  23. Patterson Caroline Marie, Nair Arjun, Ahmed Nabeel, Bryan Leoni, Bell Derek, Nicol Edward David, Clinical outcomes when applying NICE guidance for the investigation of recent-onset chest pain to a rapid-access chest pain clinic population, 10.1136/heartjnl-2014-306180
  24. McKavanagh Peter, Lusk Lisa, Ball Peter A., Trinick Tom R., Duly Ellie, Walls Gerard M., Orr Clare, Harbinson Mark T., Donnelly Patrick M., A comparison of Diamond Forrester and coronary calcium scores as gatekeepers for investigations of stable chest pain, 10.1007/s10554-013-0226-6
  25. Pavitt Chris W, Harron Katie, Lindsay Alistair C, Ray Robin, Zielke Sayeh, Rubens Michael B, Padley Simon P, Nicol Ed D, 147 Deriving Coronary Artery Calcium Scores from CT Coronary Angiography: A Potential for Change to the UK Nice Guidelines on Stable Chest Pain, 10.1136/heartjnl-2014-306118.147
  26. Genders T. S. S., Steyerberg E. W., Alkadhi H., Leschka S., Desbiolles L., Nieman K., Galema T. W., Meijboom W. B., Mollet N. R., de Feyter P. J., Cademartiri F., Maffei E., Dewey M., Zimmermann E., Laule M., Pugliese F., Barbagallo R., Sinitsyn V., Bogaert J., Goetschalckx K., Schoepf U. J., Rowe G. W., Schuijf J. D., Bax J. J., de Graaf F. R., Knuuti J., Kajander S., van Mieghem C. A. G., Meijs M. F. L., Cramer M. J., Gopalan D., Feuchtner G., Friedrich G., Krestin G. P., Hunink M. G. M., , A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension, 10.1093/eurheartj/ehr014
  27. The Story Behind the Image, 10.1148/radiol.13130278
  28. Target cardiovascular risk rather than cholesterol concentration, 10.1136/bmj.f7110
  29. Zylka-Menhorn V (2013) Kurswechel löst heftigen Streit aus. Deutsches Ärzteblatt 110(50):A2425–A2426
  30. Goff DC Jr, Lloyd-Jones DM, Bennett G et al (2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129(suppl 2):S49–S73
Bibliographic reference Roehle, Robert ; Wieske, Viktoria ; Schuetz, Georg M ; Gueret, Pascal ; Andreini, Daniele ; et. al. Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.. In: European Radiology, Vol. 28, no. 9, p. 4006-4017 (2018)
Permanent URL http://hdl.handle.net/2078.1/196954