Introduction. The 2019 European Society of Cardiology (ESC) pre-test probability (PTP) model is widely used for predicting obstructive coronary artery disease (CAD) in patients with stable angina, though its accuracy in various populations is uncertain.
The objective of the study was to evaluate the diagnostic accuracy of the 2019 ESC PTP model in predicting obstructive CAD in stable angina patients and to assess the added value of incorporating traditional cardiovascular risk factors.
Material and methods. A cross-sectional study included 366 stable angina patients who underwent coronary computed tomography angiography. Obstructive CAD was defined as ≥50% stenosis. The 2019 ESC PTP model was applied, and a revised model including additional risk factors (hypertension, diabetes, smoking, family history of premature CAD, and LDL-C/HDL-C ratio) was developed. Discrimination and calibration were evaluated using c-statistic and Hosmer-Lemeshow test.
Results. The actual prevalence of obstructive CAD was 73.8%, higher than the predicted values from the 2019 ESC PTP model across all risk categories (low 11.1%, intermediate 55.2%, high 82.8%). The 2019 ESC PTP model had modest discriminatory power (c-statistic =0.701, 95% confidence interval [CI]: 0.640–0.761), but incorporating traditional cardiovascular risk factors improved both discrimination (c-statistic = 0.785, 95% CI: 0.735–0.835) and calibration (Hosmer-Lemeshow test: p = 0.219). The optimism-corrected c-statistic from internal validation was 0.769, and the corrected calibration slope was 0.8891.
Conclusions. The 2019 ESC PTP model underestimates the prevalence of obstructive CAD in stable angina patients. Incorporating additional cardiovascular risk factors significantly improves the model’s predictive accuracy. External validation is needed to confirm the effectiveness of this updated nomogram in broader clinical practice.
Keywords: cardiovascular risk factors, coronary computed tomography angiography, LDL-C/HDL-C ratio, obstructive coronary artery disease, pre-test probability.
Full text sources https://doi.org/10.31688/ABMU.2024.59.4.09
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Truong H. HOANG
Address: Department of Internal Medicine, Faculty of Medicine, Pham Ngoc Thach University of Medicine, 02 Duong Quang Trung Street, Ward 12, District 10, Ho Chi Minh City, Vietnam.
E-mail: truonghh@pnt.edu.vn; Phone + (84) 32-5665-419
