ArticleEuropean heart journal2026
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.
Article in European heart journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.
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.
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.
Who cites it
1 citing paper in PubMed.
Corrections and comments
- Erratum issued
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
For individuals with suspected chronic coronary syndrome, the 2024 ESC guidelines recommend use of a structured estimate of the probability of obstructive coronary artery disease (CAD). This 'risk factor-weighted clinical likelihood' (RF-CL) model is recommended as the initial step after history taking and combines age, sex, symptom characteristics, and five clinical risk factors, with coronary calcification data, if available. The resulting numerical estimate indicates an initial 'pre-test probability' of obstructive CAD, that has been calibrated to provide improved accuracy compared with previous models. It can help triage patients for appropriate testing and identify individuals with a very low likelihood of obstructive CAD, for whom deferral of further diagnostic tests should be considered. Designed to assess the likelihood of obstructive CAD, the RF-CL model is not designed to predict ischaemia, which may occur in the absence of obstructive coronary disease and could account for patient symptoms. The score is easy and quick to use, with extensive external validation in contemporary populations including European, North American, and Asian cohorts. However, some have questioned the practical application of the RF-CL tool, citing challenges with the specificity and clarity of patient symptoms, definition and weighting of risk factors, as well as the other 'enrichment factors' that can enhance the likelihood. The RF-CL model is quantitative up to 45% and then becomes semi-quantitative/qualitative. For patients considered very high likelihood, with an estimated score > 85%, invasive coronary angiography is recommended, although how this score may be reached is not entirely clear. The RF-CL model undoubtedly improves the prediction of obstructive CAD and can 'de-risk' a significant number of symptomatic patients safely, reducing unnecessary testing. In the development and application of such a probability estimate, there is a need to strike a good balance between simplicity and usefulness, vs increased sensitivity at the expense of greater complexity. Here, the two sides of this Great Debate are presented, to help the reader better evaluate the practical usefulness of the new RF-CL assessment in predicting the probability of obstructive CAD.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.