Document Detail

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.
MedLine Citation:
PMID:  12595855     Owner:  NLM     Status:  MEDLINE    
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.
Wayne B Batchelor; Daniel B Mark; J David Knight; Christopher B Granger; Paul W Armstrong; Robert M Califf; Eric D Peterson
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  American heart journal     Volume:  145     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-21     Completed Date:  2003-03-18     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  349-55     Citation Subset:  AIM; IM    
Heart and Vascular Institute, Tallahassee Memorial Healthcare, Tallahassee, FL, USA.
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MeSH Terms
Analysis of Variance
Coronary Angiography
Coronary Disease / diagnosis*,  pathology,  radiography
Coronary Stenosis / radiography
Heart Catheterization / economics,  utilization*
Logistic Models
Middle Aged
Myocardial Infarction / therapy*
Predictive Value of Tests
ROC Curve
Treatment Outcome
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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