ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2010
Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 5 of them syntheses that pooled it.
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Who cites it
58 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Pooled it
- The Diagnosis of Chronic Coronary Heart Disease.Deutsches Arzteblatt international · 2017Pooled it
- Clinical assessment of patients with chest pain; a systematic review of predictive tools.BMC cardiovascular disorders · 2016Pooled it
- Use of expert panels to define the reference standard in diagnostic research: a systematic review of published methods and reporting.PLoS medicine · 2013Pooled it
- Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome.Annals of family medicinePooled it
- Trial
- Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations.Family practice · 2020Trial
- Trial
- Electronic risk alerts to improve primary care management of chest pain: a randomized, controlled trial.Journal of general internal medicine · 2012Trial
- Navigating chest pain online: who uses health information and what actions follow?BMC primary care · 2025Article
- The LEADING guideline: Reporting standards for expert panel, best-estimate diagnosis, and longitudinal expert all data (LEAD) methods.Comprehensive psychiatry · 2025Article
- Article
- Evaluating the Efficacy of the Marburg Heart Score to Triage Patients Presenting With Chest Pain in an Emergency Department: A Prospective, Multicenter, Observational Study.Emergency medicine international · 2025Article
- Telephone triage of chest pain in out-of-hours primary care: external validation of a symptom-based prediction rule to rule out acute coronary syndromes.Family practice · 2024Article
- The LEADING Guideline: Reporting Standards for Expert Panel, Best-Estimate Diagnosis, and Longitudinal Expert All Data (LEAD) Studies.medRxiv : the preprint server for health sciences · 2024Article
- Development and implementation of a treatment pathway to reduce coronary angiograms - lessons from a failure.BMC health services research · 2024Article
- Induced myocardial ischemia in candidates to liver transplantation without evidence of heart disease.Annals of medicine · 2023Article
- AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study.JMIR cardio · 2023Article
- Article
- Determinants of referral for suspected coronary artery disease: a qualitative study based on decision thresholds.BMC primary care · 2023Article
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care.
methodsWe conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort).
resultsThe prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result <or= 2 points), which had a sensitivity of 87.1% (95% CI 79.9%-94.2%) and a specificity of 80.8% (77.6%-83.9%).
interpretationThe prediction rule for coronary artery disease in primary care proved to be robust in the validation cohort. It can help to rule out coronary artery disease in patients presenting with chest pain in primary care.
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