Evidence map›Paper›PMID 30520944›Full record

Trial reportEuropean heart journal. Cardiovascular Imaging2019

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.

Borek Foldyna, James E Udelson, Júlia Karády, Dahlia Banerji, Michael T Lu, Thomas Mayrhofer, Daniel O Bittner, Nandini M Meyersohn, Hamed Emami, Tessa S S Genders and 4 more

Abstract readMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European heart journal. Cardiovascular Imaging, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
54citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

54 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Trial
  3. Trial
  4. Trial
  5. Trial
  6. Article
  7. Article
  8. Article
  9. Guideline for Chronic Coronary Syndrome - 2025.Arquivos brasileiros de cardiologia · 2025
    Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Review
  15. Review
  16. Review
  17. Article
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Borek FoldynaCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
James E UdelsonTufts University School of Medicine and the Cardiovascular Center, Tufts Medical Center, 800 Washington Street North, Boston, MA, USA.
Júlia KarádyCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Dahlia BanerjiCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Michael T LuCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Thomas MayrhoferCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Daniel O BittnerCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Nandini M MeyersohnCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Hamed EmamiCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Tessa S S GendersDuke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Durham, NC, USA.
Christopher B FordyceDivision of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada.
Maros FerencikCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.
Pamela S DouglasDuke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Durham, NC, USA.
Udo HoffmannCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.

Funding

Cardiac MR and CT ResearchT32HL076136 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NEILAN, TOMAS G · 2004 to 2019
$4.9M
Cardiovascular Imaging in Ischemic Heart DiseaseK24HL113128 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2012 to 2020
$1.1M
NHLBI NIH HHS K24 HL113128NHLBI NIH HHS T32 HL076136
6 · The paper itself

Abstract

aimsTo update pretest probabilities (PTP) for obstructive coronary artery disease (CAD ≥ 50%) across age, sex, and clinical symptom strata, using coronary computed tomography angiography (CTA) in a large contemporary population of patients with stable chest pain referred to non-invasive testing. METHODS AND

resultsWe included patients enrolled in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial and randomized to CTA. Exclusively level III-certified readers, blinded to demographic and clinical data, assessed the prevalence of CAD ≥ 50% in a central core lab. After comparing the recent European Society of Cardiology-Diamond and Forrester PTP (ESC-DF) with the actual observed prevalence of CAD ≥ 50%, we created a new PTP set by replacing the ESC-DF PTP with the observed prevalence of CAD ≥ 50% across strata of age, sex, and type of angina. In 4415 patients (48.3% men; 60.5 ± 8.2 years; 78% atypical angina; 11% typical angina; 11% non-anginal chest pain), the observed prevalence of CAD ≥ 50% was 13.9%, only one-third of the average ESC-DF PTP (40.6; P < 0.001 for difference). The PTP in the new set ranged 2-48% and were consistently lower than the ESC-DF PTP across all age, sex, and angina type categories. Initially, 4284/4415 (97%) patients were classified as intermediate-probability by the ESC-DF (PTP 15-85%); using the PROMISE-PTP, 50.2% of these patients were reclassified to the low PTP category (PTP < 15%).

conclusionThe ESC-DF PTP overestimate vastly the actual prevalence of CAD ≥ 50%. A new set of PTP, derived from results of non-invasive testing, may substantially reduce the need for non-invasive tests in stable chest pain.

Indexed as

Computed Tomography AngiographyCoronary AngiographyAgedAged, 80 and overCardiac-Gated Imaging TechniquesChest PainComparative Effectiveness ResearchCoronary Artery DiseaseFemaleHumansMaleMiddle AgedNorth AmericaPrevalenceProspective Studiescomputed tomography angiographycoronary stenosisDiamond and Forresterobstructive coronary artery diseasestable chest pain

Identifiers

PMID30520944
PMCPMC6477645

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.