SPC365

Pre-test probability of chronic coronary syndrome

Session: CO 01 - Doença coronária
Speaker: Miguel Carias

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.3 Coronary Artery Disease – Diagnostic Methods
Session Type: Comunicações Orais
FP Number: ---
Authors: Miguel Carias De Sousa; Francisco Cláudio; Rita Rocha; Mafalda Carrington; João Pais; Diogo Brás; Rui Guerreiro; Ângela Bento
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The pre-test probability (PTP) of a patient with clinical suspicion of chronic coronary syndrome (CCS) can be calculated through sex, age and symptoms, namely characteristic of chest pain and the presence or not of dyspnea, the latter included in the last CCS guidelines (2019).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The 2013 ESC guidelines used the updated Diamond and Forrester model to calculate PTP. The most recent 2019 guidelines changed the calculation method.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">However, PTP depends on the prevalence of CAD in the population, so the under or over-estimation of PTP can have consequences in the approach of each patient.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Compare the Diamond-Forrester model, defended by the 2013 guidelines, with the model presented in the most recent guidelines (2019), with the prevalence of coronary artery disease to see which is closer to reality.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Unicentric retrospective observational study. Patients undergoing cardiac catheterization for suspected chronic coronary syndrome with a positive ischemia test were included, including exercise stress test (treadmill ergometer), stress echocardiogram, scintigraphy or cardiac magnetic resonance. Each patient&#39;s PTP was calculated using the Diamond-Forrester model (2013 guidelines) and the model presented in the most recent guidelines. Both methods were compared with the prevalence of obstructive coronary artery disease diagnosed by cardiac catheterization, defined by the presence of coronary lesion, with luminal stenosis <span style="font-family:Symbol">&sup3;</span>50%. Statistical analysis performed using STATA v13, with p&lt;0.05 being considered as statistically significant.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">2472 patients were included, 62.66% male, with an average age of 65.13 <span style="font-family:Symbol">&plusmn;</span> 9.98 years-old. Regarding cardiovascular risk factors, 69.66% had dyslipidemia, 35.76% diabetes mellitus and 82.36% arterial hypertension.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The prevalence of CAD in the analyzed sample was higher than the PTP calculated either by the Diamond Forrester method and by the new method in patients of both sexes with atypical chest pain, non-cardiac chest pain and dyspnea (p &lt;0.05). In patients of both sexes with typical chest pain, the Diamond Forrester method overestimated and the new model underestimated the prevalence of CAD.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The new guidelines changed the method of calculating PTP, and this new method underestimates the prevalence of CAD, moving further away from the reality observed in our population. Between the two methods of calculation compared, the Diamond Forrester model was the one that came closest to the reality of our population.</span></span></span></p>