Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

Mathias Sørgaard; Jesper James Linde; Klaus Fuglsang Kofoed; Jørgen Tobias Kühl; Henning Skov Kelbæk; Walter Bjørn Nielsen; Jens Dahlgaard Hove

doi:10.1159/000438980

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

Mathias Sørgaard, Jesper James Linde, Klaus Fuglsang Kofoed, Jørgen Tobias Kühl, Henning Skov Kelbæk, Walter Bjørn Nielsen, Jens Dahlgaard Hove

Department of Clinical Medicine

6 Citations (Scopus)

Abstract

OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain.

METHODS: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA.

RESULTS: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06).

CONCLUSIONS: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

Original language	English
Journal	Cardiology
Volume	133
Issue number	1
Pages (from-to)	10-17
Number of pages	8
ISSN	0008-6312
DOIs	https://doi.org/10.1159/000438980
Publication status	Published - 1 Oct 2015

Keywords

Adult
Aged
Aged, 80 and over
Chest Pain
Cohort Studies
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Exercise Test
Female
Humans
Logistic Models
Male
Middle Aged
Practice Guidelines as Topic
Predictive Value of Tests
ROC Curve
Risk Assessment
Severity of Illness Index
Tomography, Emission-Computed, Single-Photon
Journal Article
Research Support, Non-U.S. Gov't
Validation Studies

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@article{3373ad21ec4c488eaba396840390f5c6,

title = "Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain",

abstract = "OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain.METHODS: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA.RESULTS: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06).CONCLUSIONS: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.",

keywords = "Adult, Aged, Aged, 80 and over, Chest Pain, Cohort Studies, Coronary Angiography, Coronary Artery Disease, Coronary Stenosis, Coronary Vessels, Exercise Test, Female, Humans, Logistic Models, Male, Middle Aged, Practice Guidelines as Topic, Predictive Value of Tests, ROC Curve, Risk Assessment, Severity of Illness Index, Tomography, Emission-Computed, Single-Photon, Journal Article, Research Support, Non-U.S. Gov't, Validation Studies",

author = "Mathias S{\o}rgaard and Linde, {Jesper James} and Kofoed, {Klaus Fuglsang} and K{\"u}hl, {J{\o}rgen Tobias} and Kelb{\ae}k, {Henning Skov} and Nielsen, {Walter Bj{\o}rn} and Hove, {Jens Dahlgaard}",

note = "{\textcopyright} 2015 S. Karger AG, Basel.",

year = "2015",

month = oct,

day = "1",

doi = "10.1159/000438980",

language = "English",

volume = "133",

pages = "10--17",

journal = "Cardiologia",

issn = "0008-6312",

publisher = "S Karger AG",

number = "1",

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TY - JOUR

T1 - Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

AU - Sørgaard, Mathias

AU - Linde, Jesper James

AU - Kofoed, Klaus Fuglsang

AU - Kühl, Jørgen Tobias

AU - Kelbæk, Henning Skov

AU - Nielsen, Walter Bjørn

AU - Hove, Jens Dahlgaard

PY - 2015/10/1

Y1 - 2015/10/1

N2 - OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain.METHODS: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA.RESULTS: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06).CONCLUSIONS: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

AB - OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain.METHODS: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA.RESULTS: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06).CONCLUSIONS: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Chest Pain

KW - Cohort Studies

KW - Coronary Angiography

KW - Coronary Artery Disease

KW - Coronary Stenosis

KW - Coronary Vessels

KW - Exercise Test

KW - Female

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Practice Guidelines as Topic

KW - Predictive Value of Tests

KW - ROC Curve

KW - Risk Assessment

KW - Severity of Illness Index

KW - Tomography, Emission-Computed, Single-Photon

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

KW - Validation Studies

U2 - 10.1159/000438980

DO - 10.1159/000438980

M3 - Journal article

C2 - 26389728

SN - 0008-6312

VL - 133

SP - 10

EP - 17

JO - Cardiologia

JF - Cardiologia

IS - 1

ER -

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

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Keywords

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