CLINICS

Clinics (Sao Paulo). 2017 March; 72(3): 188-196.
doi:10.6061/clinics/2017(03)10

Copyright © 2017 CLINICS

Diagnostic models of the pre-test probability of stable coronary artery disease: A systematic review

Ting He I , Xing Liu I , Nana Xu II , Ying Li II , Qiaoyu Wu I , Meilin Liu III , Hong Yuan I II *

Central South University, The Third Xiangya Hospital, Department of Cardiology, Changsha 410013

Central South University, The Third Xiangya Hospital, Center of Clinical Pharmacology, Changsha 410013

The First Hospital of Beijing University, Department of Gerontology, Beijing, The People’s Republic of China

*Corresponding author. E-mail: yuanhongxy3@163.com

received July 29, 2016; revised November 9, 2016; accepted December 16, 2016.

Abstract

A comprehensive search of PubMed and Embase was performed in January 2015 to examine the available literature on validated diagnostic models of the pre-test probability of stable coronary artery disease and to describe the characteristics of the models. Studies that were designed to develop and validate diagnostic models of pre-test probability for stable coronary artery disease were included. Data regarding baseline patient characteristics, procedural characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness were extracted. Ten studies involving the development of 12 models and two studies focusing on external validation were identified. Seven models were validated internally, and seven models were validated externally. Discrimination varied between studies that were validated internally (C statistic 0.66-0.81) and externally (0.49-0.87). Only one study presented reclassification indices. The majority of better performing models included sex, age, symptoms, diabetes, smoking, and hyperlipidemia as variables. Only two diagnostic models evaluated the effects on clinical decision making processes or patient outcomes. Most diagnostic models of the pre-test probability of stable coronary artery disease have had modest success, and very few present data regarding the effects of these models on clinical decision making processes or patient outcomes.

Keywords: Coronary Artery Disease, Risk Assessment, Pre-Test Probability, Systematic Review, Diagnosis


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