Estimating the likelihood of severe coronary artery disease.
OBJECTIVE
To determine which clinical characteristics obtained by a physician during an initial clinical examination are important for estimating the likelihood of severe coronary artery disease, and to determine whether estimates based on these characteristics remain valid when applied prospectively and in different patient groups.


METHODS
We examined clinical characteristics predictive of severe disease in 6,435 consecutive symptomatic patients referred for suspected coronary artery disease between 1969 and 1983.


RESULTS
Eleven of 23 characteristics were important for estimating the likelihood of severe coronary artery disease. A model using these characteristics accurately estimated the likelihood of severe disease in an independent sample of 2,342 patients referred since 1983. The model also accurately estimated the prevalence of severe disease in large series of patients reported in the literature.


CONCLUSIONS
These findings suggest that the clinician's initial evaluation can identify patients at high or low risk of anatomically severe coronary artery disease. Cost-conscious quality care is encouraged by identifying patients at higher risk for severe coronary artery disease who are most likely to benefit from further evaluation.
Pryor
D B
DB
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Shaw
L
L
Harrell
F E
FE
Lee
K L
KL
Hlatky
M A
MA
Mark
D B
DB
Muhlbaier
L H
LH
Califf
R M
RM
D000328:Adult; D000368:Aged; D002985:Clinical Protocols / Q000592:standards*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004562:Electrocardiography / Q000592:standards; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008487:Medical History Taking / Q000592:standards*; D008875:Middle Aged; D010808:Physical Examination / Q000592:standards*; D011237:Predictive Value of Tests; D015995:Prevalence; D013902:Radiography, Thoracic / Q000592:standards; D015203:Reproducibility of Results; D012307:Risk Factors