Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score
Background: The American Heart Association/American College of Cardiology (AHA/ACC) 2021 Chest Pain Guidelines introduced a new pre-test probability (PTP) model for obstructive coronary artery disease (CAD). The model recommends a 15 % risk cut-off for referral for further testing. Whether addition...
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| Format: | Article |
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Elsevier
2025-06-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725000752 |
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| author | Louise H Bjerking Samuel E Schmidt Kim W Skak-Hansen Simon Winther Morten Böttcher Søren Galatius Eva Prescott |
| author_facet | Louise H Bjerking Samuel E Schmidt Kim W Skak-Hansen Simon Winther Morten Böttcher Søren Galatius Eva Prescott |
| author_sort | Louise H Bjerking |
| collection | DOAJ |
| description | Background: The American Heart Association/American College of Cardiology (AHA/ACC) 2021 Chest Pain Guidelines introduced a new pre-test probability (PTP) model for obstructive coronary artery disease (CAD). The model recommends a 15 % risk cut-off for referral for further testing. Whether addition of a risk score measured from acoustic detection of coronary turbulence obtained by the noninvasive device CADScor®System (CAD-score) improves the AHA/ACC-PTP capability to assign the correct risk category has not been tested. Methods: Patients with symptoms suggestive of CAD referred for coronary CT angiography and undergoing a same-day CAD-score were included. PTP was calculated based on sex, age, and symptoms. All patients with suspected stenosis on CT angiography were referred for invasive angiography. A CAD-score ≤ 20 was used as cut-off for low likelihood of CAD. Results: The study population consisted of 2874 patients (47 % women, median age [IQR] 58 [52–65] years). PTP categorized 2044 (71 %) of patients as > 15 % amongst whom 387 (18.9 %) were re-classified to low likelihood by a CAD-score ≤ 20. In patients aged < 70 without hypertension, 37 % were re-classified to low probability. Of the 830 patients with low PTP ≤ 15 %, 68.7 % had a CAD-score ≤ 20 indicating a deferred testing strategy. Conclusion: Adding an acoustic-based CAD-score to the PTP in patients with AHA/ACC defined-PTP > 15 % risk can reduce the number of diagnostic tests by overall 19 %, and 37 % in subgroups, and may support cost-effective clinical decision-making. Moreover, CAD-score may aid risk stratification in patients, particularly with AHA/ACC-PTP ≤ 15 %. |
| format | Article |
| id | doaj-art-1eaec43af8644191b07c18d1c73e4ac8 |
| institution | OA Journals |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-1eaec43af8644191b07c18d1c73e4ac82025-08-20T02:31:00ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-06-015810167210.1016/j.ijcha.2025.101672Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk scoreLouise H Bjerking0Samuel E Schmidt1Kim W Skak-Hansen2Simon Winther3Morten Böttcher4Søren Galatius5Eva Prescott6Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Corresponding author at: Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark.Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, DenmarkDepartment of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, DenmarkDepartment of Cardiology, Gødstrup Hospital, Herning, DenmarkDepartment of Cardiology, Gødstrup Hospital, Herning, DenmarkDepartment of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, DenmarkDepartment of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, DenmarkBackground: The American Heart Association/American College of Cardiology (AHA/ACC) 2021 Chest Pain Guidelines introduced a new pre-test probability (PTP) model for obstructive coronary artery disease (CAD). The model recommends a 15 % risk cut-off for referral for further testing. Whether addition of a risk score measured from acoustic detection of coronary turbulence obtained by the noninvasive device CADScor®System (CAD-score) improves the AHA/ACC-PTP capability to assign the correct risk category has not been tested. Methods: Patients with symptoms suggestive of CAD referred for coronary CT angiography and undergoing a same-day CAD-score were included. PTP was calculated based on sex, age, and symptoms. All patients with suspected stenosis on CT angiography were referred for invasive angiography. A CAD-score ≤ 20 was used as cut-off for low likelihood of CAD. Results: The study population consisted of 2874 patients (47 % women, median age [IQR] 58 [52–65] years). PTP categorized 2044 (71 %) of patients as > 15 % amongst whom 387 (18.9 %) were re-classified to low likelihood by a CAD-score ≤ 20. In patients aged < 70 without hypertension, 37 % were re-classified to low probability. Of the 830 patients with low PTP ≤ 15 %, 68.7 % had a CAD-score ≤ 20 indicating a deferred testing strategy. Conclusion: Adding an acoustic-based CAD-score to the PTP in patients with AHA/ACC defined-PTP > 15 % risk can reduce the number of diagnostic tests by overall 19 %, and 37 % in subgroups, and may support cost-effective clinical decision-making. Moreover, CAD-score may aid risk stratification in patients, particularly with AHA/ACC-PTP ≤ 15 %.http://www.sciencedirect.com/science/article/pii/S2352906725000752Chronic coronary syndromeCoronary artery diseaseHeart soundPre-test probabilityRisk stratification |
| spellingShingle | Louise H Bjerking Samuel E Schmidt Kim W Skak-Hansen Simon Winther Morten Böttcher Søren Galatius Eva Prescott Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score International Journal of Cardiology: Heart & Vasculature Chronic coronary syndrome Coronary artery disease Heart sound Pre-test probability Risk stratification |
| title | Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score |
| title_full | Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score |
| title_fullStr | Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score |
| title_full_unstemmed | Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score |
| title_short | Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score |
| title_sort | pre test probability estimation of coronary artery disease can be improved by adding an acoustic based risk score |
| topic | Chronic coronary syndrome Coronary artery disease Heart sound Pre-test probability Risk stratification |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725000752 |
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