ArticleCirculation2011
Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: results from the multinational coronary CT angiography evaluation for clinical outcomes: an international multicenter registry (CONFIRM).
Article in Circulation, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 115 papers, 3 of them syntheses that pooled it.
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Who cites it
115 citing papers in PubMed, 3 syntheses or guidelines pooled it, 307 citations in OpenAlex.
- Update of the Brazilian Guideline on Nuclear Cardiology - 2020.Arquivos brasileiros de cardiologia · 2020Guideline
- Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data.BMJ (Clinical research ed.) · 2019Pooled it
- The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and meta-analysis.PloS one · 2014Pooled it
- Presenting Symptoms in Patients Undergoing Coronary Artery Disease Evaluation: Association With Noninvasive Test Results and Clinical Outcomes in the PROMISE Trial.Circulation. Cardiovascular quality and outcomes · 2022Trial
- Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study.European radiology · 2021Trial
- Validation of European Society of Cardiology pre-test probabilities for obstructive coronary artery disease in suspected stable angina.European heart journal. Quality of care & clinical outcomes · 2020Trial
- Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial.European heart journal. Cardiovascular Imaging · 2019Trial
- Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain.Journal of the American College of Cardiology · 2019Trial
- Identification of Patients With Stable Chest Pain Deriving Minimal Value From Noninvasive Testing: The PROMISE Minimal-Risk Tool, A Secondary Analysis of a Randomized Clinical Trial.JAMA cardiology · 2017Trial
- Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE.Current cardiology reports · 2016Trial
- Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial.JACC. Cardiovascular imaging · 2016Trial
- Outcomes of anatomical versus functional testing for coronary artery disease.The New England journal of medicine · 2015Trial
- Great debate: the new risk factor-weighted clinical likelihood model is useful to estimate the initial pre-test probability of obstructive coronary artery disease in individuals with suspected chronic coronary syndromes.European heart journal · 2026Article
- From plaque to event: coronary plaque burden and morphology in predicting adverse cardiovascular outcomes.Frontiers in cardiovascular medicine · 2026Article
- Guideline for Chronic Coronary Syndrome - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Development and validation of a deep-learning algorithm for rule-in and rule-out coronary artery disease based on electrocardiogram without evidence of myocardial ischemia.International journal of cardiology. Heart & vasculature · 2025Article
- Clinical likelihood models calibrated against observed obstructive coronary artery disease on computed tomography angiography.European heart journal. Cardiovascular Imaging · 2025Article
- Prediction of coronary artery disease based on facial temperature information captured by non-contact infrared thermography.BMJ health & care informatics · 2024Article
- [Screening, risk stratification and CT imaging for assessment of coronary artery disease].Radiologie (Heidelberg, Germany) · 2024Article
- Sex-specific and ethnicity-specific differences in MINOCA.Nature reviews. Cardiology · 2024Review
55 more citing papers are in PubMed but not listed here.
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24 authors at 1 institution in 1 country.
Funding
Abstract
backgroundGuidelines for the management of patients with suspected coronary artery disease (CAD) rely on the age, sex, and angina typicality-based pretest probabilities of angiographically significant CAD derived from invasive coronary angiography (guideline probabilities). Reliability of guideline probabilities has not been investigated in patients referred to noninvasive CAD testing. METHODS AND
resultsWe identified 14048 consecutive patients with suspected CAD who underwent coronary computed tomographic angiography. Angina typicality was recorded with the use of accepted criteria. Pretest likelihoods of CAD with ≥ 50 diameter stenosis (CAD50) and ≥ 70 diameter stenosis (CAD70) were calculated from guideline probabilities. Computed tomographic angiography images were evaluated by ≥ 1 expert reader to determine the presence of CAD50 and CAD70. Typical angina was associated with the highest prevalence of CAD50 (40 in men, 19 in women) and CAD70 (27 men, 11 women) compared with other symptom categories (P<0.001 for all). Observed CAD50 and CAD70 prevalences were substantially lower than those predicted by guideline probabilities in the overall population (18 versus 51 for CAD50, 10 versus 42 for CAD70; P<0.001), driven by pronounced differences in patients with atypical angina (15 versus 47 for CAD50, 7 versus 37 for CAD70) and typical angina (29 versus 86 for CAD50, 19 versus 71 for CAD70). Marked overestimation of disease prevalence by guideline probabilities was found at all participating centers and across all sex and age subgroups.
conclusionIn this multinational study of patients referred for coronary computed tomographic angiography, determination of pretest likelihood of angiographically significant CAD by the invasive angiography-based guideline probabilities greatly overestimates the actual prevalence of disease.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.