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Development and validation of a simple model to predict severe coronary artery disease after myocardial infarction: potential impact on cardiac catheterization use in the United States and Canada.

Publication ,  Journal Article
Batchelor, WB; Mark, DB; Knight, JD; Granger, CB; Armstrong, PW; Califf, RM; Peterson, ED
Published in: Am Heart J
February 2003

BACKGROUND: Improved patient selection may optimize the efficiency of cardiac catheterization in both high- and low-rate regions. The purpose of this study was to develop and validate a clinical model for predicting high-risk coronary artery disease (CAD) after myocardial infarction (MI) and to examine the model's potential impact on the use rate of both US and Canadian catheterization practices. METHODS AND RESULTS: By the use of baseline clinical variables from 1122 patients in the angiographic substudy of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-1) trial, we developed a model that was predictive of severe CAD (left main or triple-vessel disease). The final model, which included prior MI, age, sex, hyperlipidemia, and decreased left ventricular ejection fraction (C-index = 0.70), was externally validated in 781 patients in the GUSTO IIb trial. Although the probability of severe CAD predicted 5-year survival, the frequency of catheterization in both Canada and the United States bore no relationship to severe CAD risk in the GUSTO-1 trial. By use of the model, we estimated that as much as 15% of US catheterizations from both GUSTO-1 and GUSTO IIb might have been avoided, without significantly compromising the number of patients with severe CAD who were identified (sensitivity = 0.94). By applying the model to Canadian practices, an additional 30 cases of severe CAD might have been identified per every 1000 catheterizations performed, without increasing the catheterization rate. CONCLUSIONS: The likelihood of severe CAD after ST-elevation MI may be predicted from simple baseline clinical variables. The use of a severe CAD predictive model to guide patient selection might enhance the cost-effectiveness of both aggressive and conservative catheterization practices.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2003

Volume

145

Issue

2

Start / End Page

349 / 355

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • ROC Curve
  • Probability
  • Predictive Value of Tests
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Logistic Models
  • Humans
 

Citation

APA
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ICMJE
MLA
NLM
Batchelor, W. B., Mark, D. B., Knight, J. D., Granger, C. B., Armstrong, P. W., Califf, R. M., & Peterson, E. D. (2003). Development and validation of a simple model to predict severe coronary artery disease after myocardial infarction: potential impact on cardiac catheterization use in the United States and Canada. Am Heart J, 145(2), 349–355. https://doi.org/10.1067/mhj.2003.111
Batchelor, Wayne B., Daniel B. Mark, J David Knight, Christopher B. Granger, Paul W. Armstrong, Robert M. Califf, and Eric D. Peterson. “Development and validation of a simple model to predict severe coronary artery disease after myocardial infarction: potential impact on cardiac catheterization use in the United States and Canada.Am Heart J 145, no. 2 (February 2003): 349–55. https://doi.org/10.1067/mhj.2003.111.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2003

Volume

145

Issue

2

Start / End Page

349 / 355

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • ROC Curve
  • Probability
  • Predictive Value of Tests
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Logistic Models
  • Humans