title: Comparison of Coronary Artery Disease Consortium 1 and 2 Scores and Duke Clinical Score to Predict Obstructive Coronary Disease by Invasive Coronary Angiography.
abstract: BACKGROUND
  The first step in evaluating a patient with suspected stable coronary artery disease (CAD) is the determination of the pretest probability. The European Society of Cardiology guidelines recommend the use of the CAD Consortium 1 score (CAD1), which contrary to CAD Consortium 2 (CAD2) score and Duke Clinical Score (DCS), does not include modifiable cardiovascular risk factors.
  
  
  OBJECTIVE
  Using scores that include modifiable risk factors (DCS and CAD2) enhances prediction of CAD.
  
  
  METHODS
  We retrospectively included all patients referred to invasive coronary angiography for suspected CAD from January/2008-December/2012 (N = 2234). Pretest probability was calculated using 3 models (CAD1, DCS, and CAD2), and they were compared using the net reclassification improvement.
  
  
  RESULTS
  Mean patient age was 63.7 years, 67.5% were male, and the majority (66.9%) had typical angina. Coronary artery disease was diagnosed in 58.5%, and the area under the curve was 0.685 for DCS, 0.664 for CAD1, and 0.683 for CAD2, with a statistically significant difference between CAD1 and the others (P < 0.001). The net reclassification improvement was 20% for DCS, related to adequate reclassification of 32% of patients with CAD to a higher risk category, and 5% for CAD2, at the cost of adequate reclassification of 34% of patients without CAD to a lower risk category.
  
  
  CONCLUSIONS
  Prediction of CAD using scores that include modifiable cardiovascular risk factors seems to improve accuracy. Our results suggest that, in high-prevalence populations, DCS may better identify patients at higher risk and CAD2 those at lower risk for CAD.
authors: Department of Cardiology, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
authors: João
authors: J
authors: Almeida
authors: Department of Cardiology, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
authors: Paulo
authors: P
authors: Fonseca
authors: Department of Cardiology, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
authors: Tiago
authors: T
authors: Dias
authors: Department of Cardiology, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
authors: Ricardo
authors: R
authors: Ladeiras-Lopes
authors: Department of Cardiology, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
authors: Nuno
authors: N
authors: Bettencourt
authors: Department of Cardiology, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
authors: José
authors: J
authors: Ribeiro
authors: Department of Cardiology, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
authors: Vasco
authors: V
authors: Gama
mesh_terms: D000368:Aged; D019540:Area Under Curve; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011174:Portugal; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index