Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography Study
Background. To compare two risk assessment strategies to identify individuals likely to benefit from further imaging testing in patients with diabetes mellitus (DM) and stable chest pain (SCP) suspected of obstructive coronary artery disease (CAD). Methods. 602 DM patients referred to coronary compu...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Journal of Diabetes Research |
| Online Access: | http://dx.doi.org/10.1155/2022/8183487 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850223807011225600 |
|---|---|
| author | Jia Zhao Shuo Wang Pengyu Zhao Yong Huo Chunjie Li Jia Zhou |
| author_facet | Jia Zhao Shuo Wang Pengyu Zhao Yong Huo Chunjie Li Jia Zhou |
| author_sort | Jia Zhao |
| collection | DOAJ |
| description | Background. To compare two risk assessment strategies to identify individuals likely to benefit from further imaging testing in patients with diabetes mellitus (DM) and stable chest pain (SCP) suspected of obstructive coronary artery disease (CAD). Methods. 602 DM patients referred to coronary computed tomography angiography (CCTA) for SCP were included. They were divided into high- and low-risk groups according to the 2016 National Institute of Health and Care Excellence guideline-determined strategy (NICE strategy) which focused on symptom evaluation and 2019 European Society of Cardiology guideline-determined strategy (ESC strategy) which was based on pretest probability (PTP) sequentially determined by the ESC-PTP estimator and risk factor-weighted clinical likelihood (RF-CL) model, respectively. The associations of clinical outcomes with risk groups and net reclassification improvement (NRI) were evaluated. Results. The NICE and ESC strategy classified 44% and 39% patients into the low-risk group, respectively. Compared to the NICE strategy, the ESC strategy indicated stronger associations between risk groups and events (hazard ratios: 4.24 versus 1.91), intensive clinical management, and a positive NRI (27.71%, p<0.0001). The application of the RF-CL model ameliorated the underestimation of risk in patients with borderline ESC-PTP, which principally account for the improvement of the ESC strategy. Conclusion. Compared to the NICE strategy, the ESC strategy seemed to be associated with greater efficiency in identifying high risk individuals in patients with DM and SCP. |
| format | Article |
| id | doaj-art-43b3311b4f524f52bce7e07bcc8f5c28 |
| institution | OA Journals |
| issn | 2314-6753 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Research |
| spelling | doaj-art-43b3311b4f524f52bce7e07bcc8f5c282025-08-20T02:05:49ZengWileyJournal of Diabetes Research2314-67532022-01-01202210.1155/2022/8183487Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography StudyJia Zhao0Shuo Wang1Pengyu Zhao2Yong Huo3Chunjie Li4Jia Zhou5Department of CardiologyGraduate SchoolSchool of Electrical and Information EngineeringDepartment of CardiologyDepartment of CardiologyDepartment of CardiologyBackground. To compare two risk assessment strategies to identify individuals likely to benefit from further imaging testing in patients with diabetes mellitus (DM) and stable chest pain (SCP) suspected of obstructive coronary artery disease (CAD). Methods. 602 DM patients referred to coronary computed tomography angiography (CCTA) for SCP were included. They were divided into high- and low-risk groups according to the 2016 National Institute of Health and Care Excellence guideline-determined strategy (NICE strategy) which focused on symptom evaluation and 2019 European Society of Cardiology guideline-determined strategy (ESC strategy) which was based on pretest probability (PTP) sequentially determined by the ESC-PTP estimator and risk factor-weighted clinical likelihood (RF-CL) model, respectively. The associations of clinical outcomes with risk groups and net reclassification improvement (NRI) were evaluated. Results. The NICE and ESC strategy classified 44% and 39% patients into the low-risk group, respectively. Compared to the NICE strategy, the ESC strategy indicated stronger associations between risk groups and events (hazard ratios: 4.24 versus 1.91), intensive clinical management, and a positive NRI (27.71%, p<0.0001). The application of the RF-CL model ameliorated the underestimation of risk in patients with borderline ESC-PTP, which principally account for the improvement of the ESC strategy. Conclusion. Compared to the NICE strategy, the ESC strategy seemed to be associated with greater efficiency in identifying high risk individuals in patients with DM and SCP.http://dx.doi.org/10.1155/2022/8183487 |
| spellingShingle | Jia Zhao Shuo Wang Pengyu Zhao Yong Huo Chunjie Li Jia Zhou Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography Study Journal of Diabetes Research |
| title | Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography Study |
| title_full | Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography Study |
| title_fullStr | Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography Study |
| title_full_unstemmed | Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography Study |
| title_short | Comparison of Risk Assessment Strategies for Patients with Diabetes Mellitus and Stable Chest Pain: A Coronary Computed Tomography Angiography Study |
| title_sort | comparison of risk assessment strategies for patients with diabetes mellitus and stable chest pain a coronary computed tomography angiography study |
| url | http://dx.doi.org/10.1155/2022/8183487 |
| work_keys_str_mv | AT jiazhao comparisonofriskassessmentstrategiesforpatientswithdiabetesmellitusandstablechestpainacoronarycomputedtomographyangiographystudy AT shuowang comparisonofriskassessmentstrategiesforpatientswithdiabetesmellitusandstablechestpainacoronarycomputedtomographyangiographystudy AT pengyuzhao comparisonofriskassessmentstrategiesforpatientswithdiabetesmellitusandstablechestpainacoronarycomputedtomographyangiographystudy AT yonghuo comparisonofriskassessmentstrategiesforpatientswithdiabetesmellitusandstablechestpainacoronarycomputedtomographyangiographystudy AT chunjieli comparisonofriskassessmentstrategiesforpatientswithdiabetesmellitusandstablechestpainacoronarycomputedtomographyangiographystudy AT jiazhou comparisonofriskassessmentstrategiesforpatientswithdiabetesmellitusandstablechestpainacoronarycomputedtomographyangiographystudy |