title: Medical history for prognostic risk assessment and diagnosis of stable patients with suspected coronary artery disease.
abstract: OBJECTIVE
  To develop a clinical cardiac risk algorithm for stable patients with suspected coronary artery disease based upon angina typicality and coronary artery disease risk factors.
  
  
  METHODS
  Between 2004 and 2011, 14,004 adults with suspected coronary artery disease referred for cardiac imaging were followed: 1) 9093 patients for coronary computed tomography angiography (CCTA) followed for 2.0 years (CCTA-1); 2) 2132 patients for CCTA followed for 1.6 years (CCTA-2); and 3) 2779 patients for exercise myocardial perfusion scintigraphy (MPS) followed for 5.0 years. A best-fit model from CCTA-1 for prediction of death or myocardial infarction was developed, with integer values proportional to regression coefficients. Discrimination was assessed using C-statistic. The validated model was tested for estimation of the likelihood of obstructive coronary artery disease, defined as ≥50% stenosis, as compared with the method of Diamond and Forrester. Primary outcomes included all-cause mortality and nonfatal myocardial infarction. Secondary outcomes included prevalent angiographically obstructive coronary artery disease.
  
  
  RESULTS
  In CCTA-1, best-fit model discriminated individuals at risk of death or myocardial infarction (C-statistic 0.76). The integer model ranged from 3 to 13, corresponding to 3-year death risk or myocardial infarction of 0.25% to 53.8%. When applied to CCTA-2 and MPS cohorts, the model demonstrated C-statistics of 0.71 and 0.77, respectively. Both best-fit (C = 0.76; 95% confidence interval [CI], 0.746-0.771) and integer models (C = 0.71; 95% CI, 0.693-0.719) performed better than Diamond and Forrester (C = 0.64; 95% CI, 0.628-0.659) for estimating obstructive coronary artery disease.
  
  
  CONCLUSIONS
  For stable symptomatic patients with suspected coronary artery disease, we developed a history-based method for prediction of death and obstructive coronary artery disease.
authors: Department of Radiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York. Electronic address: jkm2001@med.cornell.edu.
authors: James K
authors: JK
authors: Min
authors: Department of Public Health, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York.
authors: Allison
authors: A
authors: Dunning
authors: Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif.
authors: Heidi
authors: H
authors: Gransar
authors: Department of Medicine, University of Erlangen, Erlangen, Germany.
authors: Stephan
authors: S
authors: Achenbach
authors: Department of Medicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York.
authors: Fay Y
authors: FY
authors: Lin
authors: Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Mich.
authors: Mouaz
authors: M
authors: Al-Mallah
authors: Department of Medicine, Harbor UCLA Medical Center, Los Angeles, Calif.
authors: Matthew J
authors: MJ
authors: Budoff
authors: Tennessee Heart and Vascular Institute, Hendersonville.
authors: Tracy Q
authors: TQ
authors: Callister
authors: Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea.
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Cardiovascular Radiology Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy; Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Filippo
authors: F
authors: Cademartiri
authors: Cardiovascular Radiology Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy; Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Erica
authors: E
authors: Maffei
authors: William Beaumont Hospital, Royal Oaks, Mich.
authors: Kavitha
authors: K
authors: Chinnaiyan
authors: Department of Medicine and Radiology, University of Ottawa Heart Institute, Ontario, Canada.
authors: Benjamin J W
authors: BJ
authors: Chow
authors: Department of Biostatistics, Boston University, Boston, Mass.
authors: Ralph
authors: R
authors: D'Agostino
authors: Capitol Cardiology Associates, Albany, NY.
authors: Augustin
authors: A
authors: DeLago
authors: Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif.
authors: John
authors: J
authors: Friedman
authors: Division of Cardiology, Deutsches Herzzentrum München, Munich, Germany.
authors: Martin
authors: M
authors: Hadamitzky
authors: Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
authors: Joerg
authors: J
authors: Hausleiter
authors: Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif.
authors: Sean W
authors: SW
authors: Hayes
authors: University Hospital, Zurich, Switzerland.
authors: Philipp
authors: P
authors: Kaufmann
authors: William Beaumont Hospital, Royal Oaks, Mich.
authors: Gilbert L
authors: GL
authors: Raff
authors: Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
authors: Leslee J
authors: LJ
authors: Shaw
authors: Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif.
authors: Louise
authors: L
authors: Thomson
authors: Department of Medicine, Walter Reed Medical Center, Washington, DC.
authors: Todd
authors: T
authors: Villines
authors: Baptist Cardiac and Vascular Institute, Miami, Fla.
authors: Ricardo C
authors: RC
authors: Cury
authors: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Gudrun
authors: G
authors: Feuchtner
authors: Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea.
authors: Yong-Jin
authors: YJ
authors: Kim
authors: Division of Cardiology and Department of Medical Imaging, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
authors: Jonathon
authors: J
authors: Leipsic
authors: Hospital da Luz, Lisboa, Portugal.
authors: Hugo
authors: H
authors: Marques
authors: Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif.
authors: Daniel S
authors: DS
authors: Berman
authors: Department of Biostatistics, Boston University and Harvard Clinical Research Institute, Boston, Mass.
authors: Michael
authors: M
authors: Pencina
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Coronary artery disease; Diagnosis; Prognosis